Provider Demographics
NPI:1790806263
Name:ZHANG, RANDY (OMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N.EASTMAN RD SUITE 2
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3375
Mailing Address - Country:US
Mailing Address - Phone:903-757-0620
Mailing Address - Fax:903-753-7196
Practice Address - Street 1:1800 N EASTMAN RD STE 2
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3375
Practice Address - Country:US
Practice Address - Phone:903-757-0620
Practice Address - Fax:903-753-7196
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00132171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist