Healthcare Provider Details

I. General information

NPI: 1780105288
Provider Name (Legal Business Name): ZHENGUO ZHANG LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 FORREST AVE
DOVER DE
19904-3329
US

IV. Provider business mailing address

30075 STAGE COACH CIR
MILFORD DE
19963-4188
US

V. Phone/Fax

Practice location:
  • Phone: 302-393-1431
  • Fax: 302-393-1431
Mailing address:
  • Phone: 302-393-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCQ-0000036
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: