MEDICARE: MING REN ZHANG

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	122300000X	Dentist	103981	CA

General Provider Information

NPI Number	:	1114565264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MING REN ZHANG

Provider Business Mailing Address
First Line	:	7930 HERSHEY ST
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2462
Country	:	US
Telephone Number	:
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	:	269-312-5256
Fax Number	:

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

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	09/03/2021

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Directions to “ MING REN ZHANG ” Practice Location

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