Provider Demographics
NPI:1942687322
Name:STREAM OF LIFE
Entity Type:Organization
Organization Name:STREAM OF LIFE
Other - Org Name:XUEJUN ZHANG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL NUTRITIONIST
Authorized Official - Prefix:DR
Authorized Official - First Name:XUEJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:CCN, PHD
Authorized Official - Phone:214-448-3318
Mailing Address - Street 1:400 MAPLELAWN DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:214-448-3318
Mailing Address - Fax:
Practice Address - Street 1:400 MAPLELAWN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5743
Practice Address - Country:US
Practice Address - Phone:214-448-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:32039795300
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5004251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare