Provider Demographics
NPI:1649462623
Name:ZENG, BRUCE (LAC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ZENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:SHAOBO
Other - Middle Name:
Other - Last Name:ZENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:SUITE 238
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-842-1688
Mailing Address - Fax:818-842-1638
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:SUITE 238
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-842-1688
Practice Address - Fax:818-842-1638
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC10201OtherACUPUNCTURE BOARD