Healthcare Provider Details

I. General information

NPI: 1336628866
Provider Name (Legal Business Name): SHEN ZHANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAC18161
License Number StateCA

VIII. Authorized Official

Name: SHEN ZHANG
Title or Position: OWNER
Credential:
Phone: 650-785-7727