Provider Demographics
NPI:1952871212
Name:KONG, ZHANGLIN (MS RDN CDCES)
Entity type:Individual
Prefix:
First Name:ZHANGLIN
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:MS RDN CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3956 JORDAN RANCH DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2565
Mailing Address - Country:US
Mailing Address - Phone:857-366-6175
Mailing Address - Fax:
Practice Address - Street 1:3956 JORDAN RANCH DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2565
Practice Address - Country:US
Practice Address - Phone:857-366-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3622133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3622OtherDIETITIAN/NUTRITIONIST
MDDX6035OtherDIETETIC PRACTICE LICENSE
1098983OtherREGISTERED DIETITIAN NUTRITIONIST