Healthcare Provider Details

I. General information

NPI: 1871243535
Provider Name (Legal Business Name): THOMPSON ZHUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4274
US

IV. Provider business mailing address

1605 SANSOM ST APT 502
PHILADELPHIA PA
19103-5144
US

V. Phone/Fax

Practice location:
  • Phone: 800-789-7366
  • Fax:
Mailing address:
  • Phone: 309-339-3568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: