Healthcare Provider Details

I. General information

NPI: 1235450115
Provider Name (Legal Business Name): YIFAN ZHANG MB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST PSY: PSYCHIATRY
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 980710 PSY: PSYCHIATRY
RICHMOND VA
23298-0710
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7912
  • Fax: 804-828-1472
Mailing address:
  • Phone: 804-828-7912
  • Fax: 804-828-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116022254
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: