Provider Demographics
NPI:1295769057
Name:ZHANG, FANGYUAN FRED (MD)
Entity type:Individual
Prefix:DR
First Name:FANGYUAN
Middle Name:FRED
Last Name:ZHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 E 29TH ST N STE 208
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2183
Mailing Address - Country:US
Mailing Address - Phone:316-636-5666
Mailing Address - Fax:
Practice Address - Street 1:9300 E 29TH ST N STE 208
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2183
Practice Address - Country:US
Practice Address - Phone:316-636-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96226207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI57948Medicare UPIN
FLP00331075OtherRAILROAD MEDICARE
FLU7895ZMedicare PIN