Provider Demographics
NPI:1497589113
Name:ZHU, SUSANNA (DDS)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:ZHU
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 1:50 CORAL REEF
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1904
Mailing Address - Country:US
Mailing Address - Phone:951-500-7818
Mailing Address - Fax:
Practice Address - Street 1:14415 CULVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0305
Practice Address - Country:US
Practice Address - Phone:951-500-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist