Provider Demographics
NPI:1295915437
Name:ZHAO, WANDA WAN LIAN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:WANDA
Middle Name:WAN LIAN
Last Name:ZHAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GROUP ADDRESS OF
Mailing Address - Street 2:PO BOX 45094
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 S. ELISEO AVE STE 2A
Practice Address - Street 2:SIRONA VASCULAR CENTER
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2017
Practice Address - Country:US
Practice Address - Phone:415-464-5400
Practice Address - Fax:415-464-5413
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001982363AS0400X
CA19704363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical