Provider Demographics
NPI:1679501670
Name:ZHANG, GRACE SHUANG (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:SHUANG
Last Name:ZHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 SONOMA AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4817
Mailing Address - Country:US
Mailing Address - Phone:312-320-0090
Mailing Address - Fax:
Practice Address - Street 1:1140 SONOMA AVE STE 2A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4817
Practice Address - Country:US
Practice Address - Phone:312-320-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC154185207W00000X, 207W00000X
IL036-116304207W00000X
GA077669207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000572000Medicaid
FLI67773Medicare UPIN
FL000572000Medicaid