Healthcare Provider Details

I. General information

NPI: 1710472642
Provider Name (Legal Business Name): SHEN ZHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2018
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 S DE ANZA BLVD STE A108
SAN JOSE CA
95129
US

IV. Provider business mailing address

1072 S DE ANZA BLVD STE A108
SAN JOSE CA
95129-3531
US

V. Phone/Fax

Practice location:
  • Phone: 408-213-2928
  • Fax: 408-213-2925
Mailing address:
  • Phone: 408-213-2928
  • Fax: 408-213-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC18161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: