Healthcare Provider Details

I. General information

NPI: 1356223432
Provider Name (Legal Business Name): LIXIAN ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 108TH ST APT 3C
CORONA NY
11368-2563
US

IV. Provider business mailing address

4211 108TH ST APT 3C
CORONA NY
11368-2563
US

V. Phone/Fax

Practice location:
  • Phone: 917-362-7763
  • Fax:
Mailing address:
  • Phone: 917-362-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: