Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 025103 | WA |
NPI | 1154454734 |
---|---|
Provider Name | Fan Zhang |
First Address | Bellevue, WA 98005-2322 |
Second Address | Bellevue, WA 98005-2322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |