Healthcare Provider Details

I. General information

NPI: 1386442309
Provider Name (Legal Business Name): SOPHIE ZHU D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date: 10/10/2025
Reactivation Date: 12/08/2025

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032
US

IV. Provider business mailing address

616 W 165TH ST APT 52
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-2500
  • Fax:
Mailing address:
  • Phone: 917-836-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: