Provider Demographics
NPI:1689865065
Name:YUAN, ZHENGHONG (MD)
Entity Type:Individual
Prefix:
First Name:ZHENGHONG
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E LAS TUNAS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1502
Mailing Address - Country:US
Mailing Address - Phone:626-289-9978
Mailing Address - Fax:626-289-3978
Practice Address - Street 1:360 E LAS TUNAS DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1502
Practice Address - Country:US
Practice Address - Phone:626-289-9978
Practice Address - Fax:626-289-3978
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111673207Q00000X, 207QA0000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN401ZOtherMEDICARE PTAN
CADN401ZMedicare PIN