Provider Demographics
NPI:1083716393
Name:ZHANG, SONG (OMD,)
Entity Type:Individual
Prefix:MR
First Name:SONG
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:OMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL DR STE 11C
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4118
Mailing Address - Country:US
Mailing Address - Phone:408-368-6045
Mailing Address - Fax:650-625-8881
Practice Address - Street 1:2500 HOSPITAL DR STE 11C
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4118
Practice Address - Country:US
Practice Address - Phone:408-368-6045
Practice Address - Fax:650-625-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC. #10747171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist