Healthcare Provider Details

I. General information

NPI: 1770331662
Provider Name (Legal Business Name): YU ZHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN ZHANG PSYCHOLOGIST

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 ANNAPOLIS RD
ODENTON MD
21113-1647
US

IV. Provider business mailing address

5322 SMITHS COVE LN
GREENBELT MD
20770-4193
US

V. Phone/Fax

Practice location:
  • Phone: 413-409-9691
  • Fax:
Mailing address:
  • Phone: 413-409-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07563
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: