Provider Demographics
NPI:1063945012
Name:ZHANG, CONGQI (CARE CORDINATOR)
Entity type:Individual
Prefix:
First Name:CONGQI
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:CARE CORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 N HILL ST
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2343
Mailing Address - Country:US
Mailing Address - Phone:213-808-1720
Mailing Address - Fax:626-988-5157
Practice Address - Street 1:767 N HILL ST
Practice Address - Street 2:SUITE 400B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2343
Practice Address - Country:US
Practice Address - Phone:213-808-1720
Practice Address - Fax:626-988-5157
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405300000X405300000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No405300000XOther Service ProvidersPrevention Professional