Provider Demographics
NPI:1649649070
Name:ZHANG, ZHONGYAN (DMD)
Entity type:Individual
Prefix:MS
First Name:ZHONGYAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ZHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:18695 JOSEPH-LAHAIE
Mailing Address - Street 2:
Mailing Address - City:PIERREFONDS
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H9K 1R2
Mailing Address - Country:CA
Mailing Address - Phone:514-696-7815
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4552
Practice Address - Country:US
Practice Address - Phone:212-240-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0588961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program