Provider Demographics
NPI:1154454734
Name:ZHANG, FAN
Entity Type:Individual
Prefix:
First Name:FAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 BEL RED RD STE A6
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2322
Mailing Address - Country:US
Mailing Address - Phone:425-643-8504
Mailing Address - Fax:
Practice Address - Street 1:13401 BEL RED RD STE A6
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2322
Practice Address - Country:US
Practice Address - Phone:425-643-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0251031223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health