Provider Demographics
NPI:1871830166
Name:ZHANG, CANGREN
Entity Type:Individual
Prefix:
First Name:CANGREN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11018 OLD SAINT AUGUSTINE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1023
Mailing Address - Country:US
Mailing Address - Phone:604-638-1170
Mailing Address - Fax:
Practice Address - Street 1:11018 OLD SAINT AUGUSTINE RD STE 114
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1023
Practice Address - Country:US
Practice Address - Phone:904-638-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3185171100000X
NY004769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist