Healthcare Provider Details

I. General information

NPI: 1285128637
Provider Name (Legal Business Name): TIAN RAN ZHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD ZHU MD

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S KNICKERBOCKER DR
SUNNYVALE CA
94087-1034
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 408-736-0441
  • Fax: 408-736-0722
Mailing address:
  • Phone: 800-636-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA205987
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA205987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: