Healthcare Provider Details

I. General information

NPI: 1811512189
Provider Name (Legal Business Name): LINDA ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 LINCOLN BLVD
VENICE CA
90291-2842
US

IV. Provider business mailing address

705 STONECLIFFE RD
MALVERN PA
19355-0308
US

V. Phone/Fax

Practice location:
  • Phone: 845-521-0980
  • Fax:
Mailing address:
  • Phone: 845-521-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number106561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: