Healthcare Provider Details

I. General information

NPI: 1548419385
Provider Name (Legal Business Name): ZIQIANG YU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EVERETT DR
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

1200 EVERETT DR
OKLAHOMA CITY OK
73104-5047
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-6821
  • Fax:
Mailing address:
  • Phone: 410-402-6821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number75265
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number75265
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: