Provider Demographics
NPI:1649570383
Name:WANG, ZHENYUAN (PHD)
Entity Type:Individual
Prefix:
First Name:ZHENYUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ALBANY ST
Mailing Address - Street 2:W408
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2518
Mailing Address - Country:US
Mailing Address - Phone:617-638-7083
Mailing Address - Fax:
Practice Address - Street 1:700 ALBANY ST
Practice Address - Street 2:W408
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2518
Practice Address - Country:US
Practice Address - Phone:617-638-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4306247ZC0005X
MA2863247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006321Medicaid
MA110025599AMedicaid
MA110025599AMedicaid