Provider Demographics
NPI:1245737378
Name:ZHAO, XIAO PENG (PHARMD)
Entity Type:Individual
Prefix:
First Name:XIAO
Middle Name:PENG
Last Name:ZHAO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SUTTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3505
Mailing Address - Country:US
Mailing Address - Phone:408-781-8033
Mailing Address - Fax:
Practice Address - Street 1:1000 SUTTER ST STE B
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3505
Practice Address - Country:US
Practice Address - Phone:530-216-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0021397183500000X
CA78051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD6281323OtherCA DRIVER'S LICENSE