1558352930 NPI number — ZHI ZHANG,M.D., PROF. LLC

Table of content: (NPI 1558352930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558352930 NPI number — ZHI ZHANG,M.D., PROF. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZHI ZHANG,M.D., PROF. LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558352930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2508 PRIMROSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57401-1659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-622-5100
Provider Business Mailing Address Fax Number:
605-622-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2508 PRIMROSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57401-1659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-622-5100
Provider Business Practice Location Address Fax Number:
605-622-4030
Provider Enumeration Date:
11/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZHANG
Authorized Official First Name:
ZHI
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
605-622-5100

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  4614 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207P00000X , with the licence number: 4614 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 4614 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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