Healthcare Provider Details

I. General information

NPI: 1598254906
Provider Name (Legal Business Name): XIAO ZHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 ADMIRALTY WAY STE 256
MARINA DEL REY CA
90292-5444
US

IV. Provider business mailing address

1540 BROCKTON AVE APT 204
LOS ANGELES CA
90025-2761
US

V. Phone/Fax

Practice location:
  • Phone: 310-846-8457
  • Fax:
Mailing address:
  • Phone: 412-334-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number195118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: