Healthcare Provider Details

I. General information

NPI: 1952229569
Provider Name (Legal Business Name): GREEN VICTORY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13755 VICTORY BLVD
VAN NUYS CA
91401-2348
US

IV. Provider business mailing address

13755 VICTORY BLVD
VAN NUYS CA
91401-2348
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-8839
  • Fax:
Mailing address:
  • Phone: 818-855-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KUIXING ZHANG
Title or Position: PRESIDENT
Credential: MD
Phone: 818-855-8839