MEDICARE: ZHEN RUAN

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	124Q00000X	Dental Hygienist	DH89455	MA

General Provider Information

NPI Number	:	1114424652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZHEN RUAN

Provider Business Mailing Address
First Line	:	99 OLD IRONSIDES WAY APT A
Second Line	:
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-2236
Country	:	US
Telephone Number	:	617-309-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 BLUE HILL AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02126-2122
Country	:	US
Telephone Number	:	617-296-0061
Fax Number	:

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

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/11/2018

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Directions to “ ZHEN RUAN ” Practice Location

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