Healthcare Provider Details

I. General information

NPI: 1508535436
Provider Name (Legal Business Name): CHARLES ZENG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 501
PASADENA CA
91101-2017
US

IV. Provider business mailing address

1274 N CRESCENT HEIGHTS BLVD APT 139
WEST HOLLYWOOD CA
90046-5060
US

V. Phone/Fax

Practice location:
  • Phone: 206-334-5555
  • Fax:
Mailing address:
  • Phone: 206-334-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT125683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: