Healthcare Provider Details

I. General information

NPI: 1164095220
Provider Name (Legal Business Name): JENNIFER JIAYUN ZHANG YOO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JIAYUN ZHANG OD

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOVER DR STE 100
NEWPORT BEACH CA
92660-5514
US

IV. Provider business mailing address

901 DOVER DR STE 100
NEWPORT BEACH CA
92660-5514
US

V. Phone/Fax

Practice location:
  • Phone: 949-642-0292
  • Fax:
Mailing address:
  • Phone: 949-642-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35139TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number35139TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: