Healthcare Provider Details

I. General information

NPI: 1780834770
Provider Name (Legal Business Name): ZHEN SHAO HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16917 ENADIA WAY
VAN NUYS CA
91406-3602
US

IV. Provider business mailing address

16917 ENADIA WAY
VAN NUYS CA
91406-3602
US

V. Phone/Fax

Practice location:
  • Phone: 818-401-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number237961
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number136744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: