Provider Demographics
NPI:1073760484
Name:ZHAO, SHI ZHEN (LAC)
Entity Type:Individual
Prefix:MR
First Name:SHI ZHEN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE D-144
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3901
Mailing Address - Country:US
Mailing Address - Phone:408-296-9300
Mailing Address - Fax:408-350-6170
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE D-144
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-296-9300
Practice Address - Fax:408-350-6170
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5713171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist