Healthcare Provider Details

I. General information

NPI: 1871030544
Provider Name (Legal Business Name): XIAONING ZHU I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 EVENINGSIDE DR
WEST COVINA CA
91792-1421
US

IV. Provider business mailing address

2147 EVENINGSIDE DR
WEST COVINA CA
91792-1421
US

V. Phone/Fax

Practice location:
  • Phone: 626-592-5280
  • Fax:
Mailing address:
  • Phone: 626-592-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: