Healthcare Provider Details

I. General information

NPI: 1437351657
Provider Name (Legal Business Name): WENGUANG ZHAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEVIN CHAO

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 STOCKTON ST STE 200
SAN FRANCISCO CA
94108
US

IV. Provider business mailing address

205 DE ANZA BLVD # 3
SAN MATEO CA
94402-3989
US

V. Phone/Fax

Practice location:
  • Phone: 415-398-9861
  • Fax: 415-398-4718
Mailing address:
  • Phone: 650-504-6640
  • Fax: 650-513-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberA111219
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA111219
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA111219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: