Healthcare Provider Details

I. General information

NPI: 1245660919
Provider Name (Legal Business Name): ANNIE ZHUJIANG D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2013
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14712 PARTHENIA ST STE E
PANORAMA CITY CA
91402-2992
US

IV. Provider business mailing address

1750 VIA DEL REY
SOUTH PASADENA CA
91030-4128
US

V. Phone/Fax

Practice location:
  • Phone: 818-830-6070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number63943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: