Healthcare Provider Details

I. General information

NPI: 1306646963
Provider Name (Legal Business Name): JINGWEI ZHONG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14612 34TH AVE
FLUSHING NY
11354-3134
US

IV. Provider business mailing address

14612 34TH AVE
FLUSHING NY
11354-3134
US

V. Phone/Fax

Practice location:
  • Phone: 916-465-2306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86449132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: