Provider Demographics
NPI:1255625760
Name:ZHANG, JIA XIN (DO)
Entity type:Individual
Prefix:
First Name:JIA
Middle Name:XIN
Last Name:ZHANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:435 DOYLE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4515
Mailing Address - Country:US
Mailing Address - Phone:707-527-9510
Mailing Address - Fax:707-527-1306
Practice Address - Street 1:3999 DUTCHMANS LN STE 4A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4745
Practice Address - Country:US
Practice Address - Phone:502-365-2655
Practice Address - Fax:502-365-2770
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A14902207RN0300X
MIL833249207RN0300X
KY04699207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare PIN