MEDICARE: MING ZHANG DDS INC.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1093489536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MING ZHANG DDS INC.

Provider Business Mailing Address
First Line	:	1240 N HACIENDA BLVD STE 103
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-1663
Country	:	US
Telephone Number	:	626-931-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 N HACIENDA BLVD STE 103
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-1663
Country	:	US
Telephone Number	:	626-931-2525
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MING REN ZHANG
Credential	:	DDS
Telephone Number	:	626-931-2525

Provider Enumeration Date	:	08/08/2021
Last Update Date	:	08/18/2021

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