Healthcare Provider Details

I. General information

NPI: 1861545477
Provider Name (Legal Business Name): FENGSHAN ZHU L., AC., OMD,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S WELLER ST
SEATTLE WA
98104-2924
US

IV. Provider business mailing address

550 150TH PL NE
BELLEVUE WA
98007-5059
US

V. Phone/Fax

Practice location:
  • Phone: 206-748-5168
  • Fax: 206-748-5168
Mailing address:
  • Phone: 425-746-0996
  • Fax: 206-748-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000512
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: