Provider Demographics
NPI:1558331462
Name:ZANG, KERRY (DPM)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:ZANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 E MCDONALD DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6099
Mailing Address - Country:US
Mailing Address - Phone:480-900-3434
Mailing Address - Fax:
Practice Address - Street 1:1620 S STAPLEY DR
Practice Address - Street 2:#132
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204
Practice Address - Country:US
Practice Address - Phone:480-834-8804
Practice Address - Fax:480-464-8287
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0079213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T76760Medicare UPIN
48WCHHT05Medicare ID - Type Unspecified