Provider Demographics
NPI:1255681425
Name:ZHOU, ZHIYU
Entity Type:Individual
Prefix:
First Name:ZHIYU
Middle Name:
Last Name:ZHOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15412 LONGWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6268
Mailing Address - Country:US
Mailing Address - Phone:626-782-3899
Mailing Address - Fax:
Practice Address - Street 1:12651 LAKEWOOD BLVD
Practice Address - Street 2:#101
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4561
Practice Address - Country:US
Practice Address - Phone:562-904-1150
Practice Address - Fax:562-904-1160
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27034124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist