=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043701204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHENG ZHU DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2018
-----------------------------------------------------
Last Update Date | 05/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1894 CONTRA COSTA BLVD
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-692-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1894 CONTRA COSTA BLVD
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-692-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | CHENG ZHU
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 925-692-2010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 61992
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------