Provider Demographics
NPI:1114412095
Name:ZHANG, KEN ZHONGYU (MD)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:ZHONGYU
Last Name:ZHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:FREEMANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7214
Mailing Address - Country:US
Mailing Address - Phone:609-670-2186
Mailing Address - Fax:
Practice Address - Street 1:2830 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-4204
Practice Address - Country:US
Practice Address - Phone:484-526-3550
Practice Address - Fax:833-822-5230
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT216672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine