Healthcare Provider Details

I. General information

NPI: 1861908188
Provider Name (Legal Business Name): SHENRU ZHAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 12/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 S DE ANZA BLVD
SAN JOSE CA
95129-4608
US

IV. Provider business mailing address

799 SPRINGWOOD DR
SAN JOSE CA
95129-2152
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-8404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: