Provider Demographics
NPI:1366642076
Name:GUAN, ZHIXIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZHIXIN
Middle Name:
Last Name:GUAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 S SEPULVEDA BLVD
Mailing Address - Street 2:APT. 106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4211
Mailing Address - Country:US
Mailing Address - Phone:415-606-0197
Mailing Address - Fax:
Practice Address - Street 1:3251 S SEPULVEDA BLVD
Practice Address - Street 2:APT. 106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4211
Practice Address - Country:US
Practice Address - Phone:415-606-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009753122300000X
CA585591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice