Healthcare Provider Details

I. General information

NPI: 1912516477
Provider Name (Legal Business Name): DONGWAN ZHU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SAN LUCAR CT
SUNNYVALE CA
94086-5213
US

IV. Provider business mailing address

2174 34TH ST
SACRAMENTO CA
95817-1209
US

V. Phone/Fax

Practice location:
  • Phone: 855-816-7705
  • Fax:
Mailing address:
  • Phone: 814-923-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86105313
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: