Provider Demographics
NPI:1518632793
Name:ZHANG, ELLEN CAOYUAN
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CAOYUAN
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 1:17621 IRVINE BLVD # 118
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3114
Mailing Address - Country:US
Mailing Address - Phone:949-346-1619
Mailing Address - Fax:
Practice Address - Street 1:17621 IRVINE BLVD # 118
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3114
Practice Address - Country:US
Practice Address - Phone:949-346-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist