Healthcare Provider Details

I. General information

NPI: 1548099781
Provider Name (Legal Business Name): YUTONG ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 BRAGG BLVD
FAYETTEVILLE NC
28303-3957
US

IV. Provider business mailing address

3025 VALENTINA WAY APT 305
FAYETTEVILLE NC
28303-7816
US

V. Phone/Fax

Practice location:
  • Phone: 910-302-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: