Healthcare Provider Details

I. General information

NPI: 1740515840
Provider Name (Legal Business Name): MR. TIANWEI ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 FOUR SEASONS SHOPPING CTR SUITE 118
CHESTERFIELD MO
63017-3195
US

IV. Provider business mailing address

42 FOUR SEASONS SHOPPING CTR SUITE 118
CHESTERFIELD MO
63017-3195
US

V. Phone/Fax

Practice location:
  • Phone: 636-578-3887
  • Fax:
Mailing address:
  • Phone: 636-578-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2002021144
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: