Provider Demographics
NPI:1942838792
Name:ZHAO, HARRY ZIYU (DO)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:ZIYU
Last Name:ZHAO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 160
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3990
Mailing Address - Country:US
Mailing Address - Phone:714-504-6772
Mailing Address - Fax:
Practice Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 160
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3990
Practice Address - Country:US
Practice Address - Phone:909-606-8893
Practice Address - Fax:909-606-8828
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A21209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program