Provider Demographics
NPI: | 1437351657 |
---|---|
Name: | ZHAO, WENGUANG (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | WENGUANG |
Middle Name: | |
Last Name: | ZHAO |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | KEVIN |
Other - Middle Name: | |
Other - Last Name: | CHAO |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | |
Mailing Address - Street 1: | 205 DE ANZA BLVD # 3 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN MATEO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94402-3989 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 650-504-6640 |
Mailing Address - Fax: | 650-513-1066 |
Practice Address - Street 1: | 950 STOCKTON ST STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94108 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-398-9861 |
Practice Address - Fax: | 415-398-4718 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-06-01 |
Last Update Date: | 2019-11-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A111219 | 207QS1201X, 208M00000X, 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QS1201X | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |