Provider Demographics
NPI:1497165781
Name:JUNLI ZHA MD PHD CORPORATION
Entity Type:Organization
Organization Name:JUNLI ZHA MD PHD CORPORATION
Other - Org Name:DR ZHA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:949-262-0838
Mailing Address - Street 1:4980 BARRANCA PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8654
Mailing Address - Country:US
Mailing Address - Phone:949-262-0838
Mailing Address - Fax:949-656-7081
Practice Address - Street 1:4980 BARRANCA PKWY STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8654
Practice Address - Country:US
Practice Address - Phone:949-262-0838
Practice Address - Fax:949-656-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76073207R00000X, 261Q00000X, 261QH0100X, 261QM1300X, 261QR0800X
ANTI-AGING2083P0901X
261QP2300X
CAA760730261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
BZ7757670OtherDEA