Healthcare Provider Details

I. General information

NPI: 1013598804
Provider Name (Legal Business Name): DAWEI ZHAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/22/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER STE 500
LOS ANGELES CA
90045-9212
US

IV. Provider business mailing address

6801 PARK TER STE 500
LOS ANGELES CA
90045-9212
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7235
  • Fax: 310-665-7296
Mailing address:
  • Phone: 310-665-7235
  • Fax: 310-665-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA195770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: