Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 100622 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 36103 | TX |
NPI | 1073968806 |
---|---|
Provider Name | Wansheng Zhu |
First Address | San Gabriel, CA 91775-3006 |
Second Address | Los Angeles, CA 90033-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 12/05/2020 |