Healthcare Provider Details

I. General information

NPI: 1114217304
Provider Name (Legal Business Name): DE-AN ZHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S FAIR OAKS AVE
PASADENA CA
91105-2625
US

IV. Provider business mailing address

PO BOX 8500 SHRINERS HOSPITALS FOR CHILDREN
PHILADELPHIA PA
19178-8113
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-9300
  • Fax: 626-389-9336
Mailing address:
  • Phone: 813-281-8478
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA125728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: