Provider Demographics
NPI:1912051509
Name:ZHANG, MICHAEL (OMD,MS,LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:OMD,MS,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7805
Mailing Address - Country:US
Mailing Address - Phone:559-226-3216
Mailing Address - Fax:559-226-3216
Practice Address - Street 1:5117 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7805
Practice Address - Country:US
Practice Address - Phone:559-226-3216
Practice Address - Fax:559-226-3216
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10068171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0100680Medicaid
CACA0100680OtherBLUESHIELD PROVIDER ID