Provider Demographics
NPI:1922404425
Name:ZAU, ELENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:ZAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 SEPULVEDA BLVD
Mailing Address - Street 2:APT 119
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4925
Mailing Address - Country:US
Mailing Address - Phone:818-259-7033
Mailing Address - Fax:
Practice Address - Street 1:7440 SEPULVEDA BLVD
Practice Address - Street 2:APT 119
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4925
Practice Address - Country:US
Practice Address - Phone:818-259-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64189122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice