Healthcare Provider Details

I. General information

NPI: 1427634013
Provider Name (Legal Business Name): TYCHE XIAYUN ZHUGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: XIAYUN ZHUGE

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 VANILLA WALKWAY
SAN JOSE CA
95133-2183
US

IV. Provider business mailing address

1050 VANILLA WALKWAY
SAN JOSE CA
95133-2183
US

V. Phone/Fax

Practice location:
  • Phone: 917-580-3089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102549
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: