Provider Demographics
NPI:1023389913
Name:CHU ZHANG DDS PROF DENTAL CORP
Entity Type:Organization
Organization Name:CHU ZHANG DDS PROF DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHU
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-863-1234
Mailing Address - Street 1:12065 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4130
Mailing Address - Country:US
Mailing Address - Phone:562-863-1234
Mailing Address - Fax:562-863-7852
Practice Address - Street 1:12065 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4130
Practice Address - Country:US
Practice Address - Phone:562-863-1234
Practice Address - Fax:562-863-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54545261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental