Provider Demographics
NPI:1629133780
Name:GREENZANG, TED R (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:R
Last Name:GREENZANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2010 E 1ST ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4083
Mailing Address - Country:US
Mailing Address - Phone:714-836-0741
Mailing Address - Fax:714-836-5657
Practice Address - Street 1:2010 E 1ST ST STE 240
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4083
Practice Address - Country:US
Practice Address - Phone:714-836-0741
Practice Address - Fax:714-836-5657
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG402252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry