1528192135 NPI number — GENGXIN ZHANG ACUPUNCTURIST INC

Table of content: (NPI 1528192135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528192135 NPI number — GENGXIN ZHANG ACUPUNCTURIST INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENGXIN ZHANG ACUPUNCTURIST INC
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:
LIVE OAK NATURAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1528192135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 E LIVE OAK AVE
Provider Second Line Business Mailing Address:
#108
Provider Business Mailing Address City Name:
ARCADIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91006-5251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-574-3038
Provider Business Mailing Address Fax Number:
626-574-9145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 E LIVE OAK AVE
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91006-5251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-574-3038
Provider Business Practice Location Address Fax Number:
626-574-9145
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZHANG
Authorized Official First Name:
GENGXIN
Authorized Official Middle Name:
Authorized Official Title or Position:
L.A.C.
Authorized Official Telephone Number:
626-574-3038

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC3721 , 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)

  • Identifier: 1902849367 . This is a "MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1740356773 . This is a "ACUPUNCTURIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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