Healthcare Provider Details

I. General information

NPI: 1164017489
Provider Name (Legal Business Name): LIN DAN ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 PACIFIC AVE
SANTA ROSA CA
95404-3568
US

IV. Provider business mailing address

1551 PACIFIC AVE
SANTA ROSA CA
95404-3568
US

V. Phone/Fax

Practice location:
  • Phone: 707-586-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: