Healthcare Provider Details

I. General information

NPI: 1437949823
Provider Name (Legal Business Name): LEEROY LEVI ZHANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CANYON RD STE A1
BULLHEAD CITY AZ
86442-8492
US

IV. Provider business mailing address

2500 CANYON RD STE A1
BULLHEAD CITY AZ
86442-8492
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-4499
  • Fax: 928-704-4949
Mailing address:
  • Phone: 928-704-4499
  • Fax: 928-704-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11252
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: