Provider Demographics
NPI:1164466322
Name:ZHANG, YI (MD)
Entity Type:Individual
Prefix:DR
First Name:YI
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 HAVEN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3804
Mailing Address - Country:US
Mailing Address - Phone:909-941-2273
Mailing Address - Fax:909-477-8830
Practice Address - Street 1:6417 HAVEN AVE STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3804
Practice Address - Country:US
Practice Address - Phone:909-941-2273
Practice Address - Fax:909-477-8830
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61239207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A612390Medicaid
CA00A612393Medicare PIN
CAG91588Medicare UPIN
HA61239Medicare PIN
CA00A612391Medicare PIN
CA00A612390Medicaid