Provider Demographics
NPI:1427366251
Name:ZHENGHONG YUAN MD INC
Entity type:Organization
Organization Name:ZHENGHONG YUAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZHENGHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-289-9978
Mailing Address - Street 1:360 E LAS TUNAS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1502
Mailing Address - Country:US
Mailing Address - Phone:626-289-9978
Mailing Address - Fax:626-289-3978
Practice Address - Street 1:360 E LAS TUNAS DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1502
Practice Address - Country:US
Practice Address - Phone:626-289-9978
Practice Address - Fax:626-289-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111673261QF0050X, 261QP2000X, 261QP2300X, 261QP3300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DL329AOtherMEDICARE PTAN