1134514680 NPI number — CHRISTINA TANAKA ZHANG M.D.

Table of content: CHRISTINA TANAKA ZHANG M.D. (NPI 1134514680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134514680 NPI number — CHRISTINA TANAKA ZHANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZHANG
Provider First Name:
CHRISTINA
Provider Middle Name:
TANAKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANAKA
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
BERNADENE YUKIKO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134514680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 S WOOD ST
Provider Second Line Business Mailing Address:
DEPARTMENT OF PEDIATRICS, MC 856
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-996-6043
Provider Business Mailing Address Fax Number:
312-413-0243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4650 W SUNSET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-6062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-631-2452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2015

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: 2080P0214X , with the licence number:  A161575 , 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)





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