=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598214314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TODD K. ZYNDA, DO INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2016
-----------------------------------------------------
Last Update Date | 03/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 ATLANTIC AVE STE 611
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90813-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-432-0111
-----------------------------------------------------
Fax | 562-276-0799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4980
-----------------------------------------------------
City | PALOS VERDES PENINSULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90274-9648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-432-0111
-----------------------------------------------------
Fax | 562-276-0799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TODD K ZYNDA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 562-432-0111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 20A10401
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------