Basic Information
| Provider Information | |||||||||
| NPI: | 1255625760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZHANG | ||||||||
| FirstName: | JIA | ||||||||
| MiddleName: | XIN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 DOYLE PARK DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075279510 | ||||||||
| FaxNumber: | 7075271306 | ||||||||
| Practice Location | |||||||||
| Address1: | 3999 DUTCHMANS LN STE 4A | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023652655 | ||||||||
| FaxNumber: | 5023652770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2011 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 20A14902 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | L833249 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 04699 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.