Healthcare Provider Details

I. General information

NPI: 1689904898
Provider Name (Legal Business Name): CHANG CAI ZOU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-2001
US

IV. Provider business mailing address

3413 JASPER ST
PHILADELPHIA PA
19134-2001
US

V. Phone/Fax

Practice location:
  • Phone: 347-840-4165
  • Fax:
Mailing address:
  • Phone: 347-840-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: