Healthcare Provider Details

I. General information

NPI: 1326799354
Provider Name (Legal Business Name): YANCHENG ZUO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 E 3900 S
SALT LAKE CITY UT
84124-1724
US

IV. Provider business mailing address

2111 E 3900 S
SALT LAKE CITY UT
84124-1724
US

V. Phone/Fax

Practice location:
  • Phone: 801-712-7168
  • Fax:
Mailing address:
  • Phone: 801-712-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5182418-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: