Basic Information
Provider Information | |||||||||
NPI: | 1326304809 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZHANG | ||||||||
FirstName: | LUCY | ||||||||
MiddleName: | YINGXIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ZHANG | ||||||||
OtherFirstName: | YINGXIN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 900 S ELISEO DR STE 102 | ||||||||
Address2: |   | ||||||||
City: | GREENBRAE | ||||||||
State: | CA | ||||||||
PostalCode: | 949042152 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4154618200 | ||||||||
FaxNumber: | 4154614627 | ||||||||
Practice Location | |||||||||
Address1: | 900 S ELISEO DR STE 102 | ||||||||
Address2: |   | ||||||||
City: | GREENBRAE | ||||||||
State: | CA | ||||||||
PostalCode: | 94904 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4154618200 | ||||||||
FaxNumber: | 4154614627 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/09/2012 | ||||||||
LastUpdateDate: | 09/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0120X | A148929 | CA | Y |   |   |   |   |
No ID Information.