MEDICARE: DR. LIQING ZHANG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019027826	IL

General Provider Information

NPI Number	:	1649424672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIQING ZHANG D.D.S.

Provider Business Mailing Address
First Line	:	430 WEST ERIE STREET
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60610
Country	:	US
Telephone Number	:	312-274-0308
Fax Number	:	312-944-9499

Provider Business Practice Location Address
First Line	:	4410 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4011
Country	:	US
Telephone Number	:	312-254-3300
Fax Number	:	312-254-3303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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