Provider Demographics
NPI:1821069287
Name:ZHAO, ZHONG (MD)
Entity Type:Individual
Prefix:
First Name:ZHONG
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MC21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-9594
Mailing Address - Fax:651-254-3662
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MC21110Q
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-9594
Practice Address - Fax:651-254-3662
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN43838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN647652000Medicaid
110007619Medicare ID - Type Unspecified
MN647652000Medicaid