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: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 VANOWEN ST STE 305
VAN NUYS CA
91405-3604
US

IV. Provider business mailing address

15211 VANOWEN ST STE 305
VAN NUYS CA
91405-3604
US

V. Phone/Fax

Practice location:
  • Phone: 818-849-6858
  • Fax: 818-989-6005
Mailing address:
  • Phone: 818-849-6858
  • Fax: 818-989-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: