MEDICARE: DR. DOUGLAS D ZHANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A63200	CA

General Provider Information

NPI Number	:	1023074341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS D ZHANG M.D.

Provider Business Mailing Address
First Line	:	13851 E 14TH ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2628
Country	:	US
Telephone Number	:	510-351-2100
Fax Number	:	510-357-3389

Provider Business Practice Location Address
First Line	:	13851 E 14TH ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2628
Country	:	US
Telephone Number	:	510-351-2100
Fax Number	:	510-357-3389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/23/2011

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