Provider Demographics
NPI:1215160171
Name:ZHANG, CHENGYUAN (LAC)
Entity type:Individual
Prefix:DR
First Name:CHENGYUAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 BOLSA AVE SPC 176
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6625
Mailing Address - Country:US
Mailing Address - Phone:714-775-6238
Mailing Address - Fax:
Practice Address - Street 1:9702 BOLSA AVE SPC 176
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6625
Practice Address - Country:US
Practice Address - Phone:714-775-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12799171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12799OtherLAC