Healthcare Provider Details

I. General information

NPI: 1861831760
Provider Name (Legal Business Name): JENNIE ZHU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

V. Phone/Fax

Practice location:
  • Phone: 808-469-7157
  • Fax:
Mailing address:
  • Phone: 509-241-7315
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberBP10045857
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOP60622568
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: