Healthcare Provider Details

I. General information

NPI: 1962028035
Provider Name (Legal Business Name): KENNETH YANG ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-0001
US

IV. Provider business mailing address

2223 HAWES AVE # 427
DALLAS TX
75235-4602
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3111
  • Fax:
Mailing address:
  • Phone: 832-701-8463
  • 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: