1649462623 NPI number — BRUCE ZENG LAC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649462623 NPI number — BRUCE ZENG LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZENG
Provider First Name:
BRUCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZENG
Provider Other First Name:
SHAOBO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649462623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 S BUENA VISTA ST
Provider Second Line Business Mailing Address:
SUITE 238
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91505-4569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-842-1688
Provider Business Mailing Address Fax Number:
818-842-1638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S BUENA VISTA ST
Provider Second Line Business Practice Location Address:
SUITE 238
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91505-4569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-842-1688
Provider Business Practice Location Address Fax Number:
818-842-1638
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC10201 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AC10201 . This is a "ACUPUNCTURE BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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