Healthcare Provider Details

I. General information

NPI: 1639840309
Provider Name (Legal Business Name): ZENITH ANESTHESIOLOGY PAIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 GROUSE RUN DR APT 124
STOCKTON CA
95207-5373
US

IV. Provider business mailing address

4777 GROUSE RUN DR APT 124
STOCKTON CA
95207-5373
US

V. Phone/Fax

Practice location:
  • Phone: 650-492-0118
  • Fax:
Mailing address:
  • Phone: 650-492-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ZHIQIANG WANG
Title or Position: PRESIDENT
Credential: MD
Phone: 650-492-0118