Healthcare Provider Details

I. General information

NPI: 1235174640
Provider Name (Legal Business Name): REGGIE ZHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/11/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 MISSION AVE SUITE 5
CARMICHAEL CA
95608-2946
US

IV. Provider business mailing address

2101 E JEFFERSON ST
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 916-863-1496
  • Fax:
Mailing address:
  • Phone: 800-227-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA80426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: