Healthcare Provider Details

I. General information

NPI: 1063945012
Provider Name (Legal Business Name): CONGQI ZHANG CARE CORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 N HILL ST SUITE 400B
LOS ANGELES CA
90012-2343
US

IV. Provider business mailing address

767 N HILL ST SUITE 400B
LOS ANGELES CA
90012-2343
US

V. Phone/Fax

Practice location:
  • Phone: 213-808-1720
  • Fax: 626-988-5157
Mailing address:
  • Phone: 213-808-1720
  • Fax: 626-988-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number405300000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: