Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 7716092-4405 | UT |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 7716092-4405 | UT |
NPI | 1518516210 |
---|---|
Provider Name | Cuicui Zhang |
First Address | Sandy, UT 84094-1947 |
Second Address | Sandy, UT 84094-1947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2019 |
Last Update Date | 29/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3014893 | (05) | UT |