Provider Demographics
NPI:1154469153
Name:ZIA, AUSHER Y
Entity Type:Individual
Prefix:DR
First Name:AUSHER
Middle Name:Y
Last Name:ZIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BEYER PARK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1129
Mailing Address - Country:US
Mailing Address - Phone:209-634-0500
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:703 N. GOLDEN STATE BLVD.
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380
Practice Address - Country:US
Practice Address - Phone:209-634-0500
Practice Address - Fax:209-634-5038
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD48207Medicaid