MEDICARE: ZMD OF CA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1871484659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZMD OF CA PC

Provider Business Mailing Address
First Line	:	2614 W 32ND CT
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-3055
Country	:	US
Telephone Number	:	509-460-2651
Fax Number	:

Provider Business Practice Location Address
First Line	:	5567 RESEDA BLVD STE 345
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-2674
Country	:	US
Telephone Number	:	509-907-4306
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID JASON VAN DE VENTER
Credential	:
Telephone Number	:	509-907-4306

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	04/06/2026

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