Healthcare Provider Details

I. General information

NPI: 1871484659
Provider Name (Legal Business Name): ZMD OF CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5567 RESEDA BLVD STE 345
TARZANA CA
91356-2674
US

IV. Provider business mailing address

2614 W 32ND CT
KENNEWICK WA
99337-3055
US

V. Phone/Fax

Practice location:
  • Phone: 509-907-4306
  • Fax:
Mailing address:
  • Phone: 509-460-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID JASON VAN DE VENTER
Title or Position: OWNER
Credential:
Phone: 509-907-4306