Provider Demographics
NPI:1144091026
Name:ZANG, PENGJU (LAC)
Entity type:Individual
Prefix:
First Name:PENGJU
Middle Name:
Last Name:ZANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3362
Mailing Address - Country:US
Mailing Address - Phone:626-418-4707
Mailing Address - Fax:626-603-5201
Practice Address - Street 1:600 W MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3362
Practice Address - Country:US
Practice Address - Phone:626-418-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75816225700000X
CA19964171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist