Provider Demographics
NPI:1558535690
Name:ZAN, AIDONG
Entity Type:Individual
Prefix:MR
First Name:AIDONG
Middle Name:
Last Name:ZAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E BEACON ST
Mailing Address - Street 2:APT, D
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3880
Mailing Address - Country:US
Mailing Address - Phone:626-329-6816
Mailing Address - Fax:626-289-8629
Practice Address - Street 1:9353 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1934
Practice Address - Country:US
Practice Address - Phone:626-287-2988
Practice Address - Fax:626-287-1937
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner