Provider Demographics
NPI:1699883025
Name:EAST TAO CORPORATION
Entity type:Organization
Organization Name:EAST TAO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEZHUANG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-438-7178
Mailing Address - Street 1:2801 RODEO RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6503
Mailing Address - Country:US
Mailing Address - Phone:505-438-7178
Mailing Address - Fax:505-438-1056
Practice Address - Street 1:2801 RODEO RD
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6503
Practice Address - Country:US
Practice Address - Phone:505-438-7178
Practice Address - Fax:505-438-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0662625171100000X
NMMD2005-0461208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty