Basic Information
| Provider Information | |||||||||
| NPI: | 1861792715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZHU | ||||||||
| FirstName: | FANG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1740 W TAYLOR ST RM 2510 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606127232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129960235 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1740 W TAYLOR ST RM 2510 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606127232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129960235 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2010 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | MD60958890 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | MD60958890 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207U00000X | MD60958890 | WA | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0414577 | 01 | WA | L&I-RADIA KING COUNTY | OTHER | 0414585 | 01 | WA | L&I-EVERGREEN RADIA | OTHER | 0414586 | 01 | WA | L&I-SOUTH SOUND RADIOLOGY | OTHER | 0414587 | 01 | WA | L&I-SEATTLE RADIOLOGY | OTHER | 0414574 | 01 | WA | L&I-RADIA REST OF WA | OTHER | 0414583 | 01 | WA | L&I-SWEDISH RADIA EDMONDS | OTHER | 2140881 | 05 | WA | MEDICAID |