Basic Information
| Provider Information | |||||||||
| NPI: | 1558535690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAN | ||||||||
| FirstName: | AIDONG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 E BEACON ST | ||||||||
| Address2: | APT, D | ||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918013880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263296816 | ||||||||
| FaxNumber: | 6262898629 | ||||||||
| Practice Location | |||||||||
| Address1: | 9353 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917701934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262872988 | ||||||||
| FaxNumber: | 6262871937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2008 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.