Healthcare Provider Details

I. General information

NPI: 1760795280
Provider Name (Legal Business Name): WENYAN ZHU D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 W END AVE APT 15A
NEW YORK NY
10025-5455
US

IV. Provider business mailing address

785 W END AVE APT 15A
NEW YORK NY
10025-5455
US

V. Phone/Fax

Practice location:
  • Phone: 646-684-4783
  • Fax:
Mailing address:
  • Phone: 646-684-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0549921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: