Provider Demographics
NPI:1356703375
Name:ZHAO, BECKY (MD)
Entity type:Individual
Prefix:DR
First Name:BECKY
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3521
Mailing Address - Country:US
Mailing Address - Phone:626-969-7885
Mailing Address - Fax:626-969-9686
Practice Address - Street 1:150 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3521
Practice Address - Country:US
Practice Address - Phone:626-969-7885
Practice Address - Fax:626-969-9686
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187010208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program