Provider Demographics
NPI:1629697438
Name:GENG, XIANZHANG (MD)
Entity type:Individual
Prefix:
First Name:XIANZHANG
Middle Name:
Last Name:GENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:GENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6240 W SUNSET BLVD APT 124
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8754
Mailing Address - Country:US
Mailing Address - Phone:213-413-6666
Mailing Address - Fax:
Practice Address - Street 1:741 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4021
Practice Address - Country:US
Practice Address - Phone:213-413-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA194201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty