Provider Demographics
NPI:1417418856
Name:ZHANG, RAY RUI (PHD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:RUI
Last Name:ZHANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E ONTARIO ST APT 813
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6945
Mailing Address - Country:US
Mailing Address - Phone:608-770-9649
Mailing Address - Fax:
Practice Address - Street 1:333 E ONTARIO ST APT 813
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6945
Practice Address - Country:US
Practice Address - Phone:608-770-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.073727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program