Provider Demographics
NPI:1679251102
Name:ZHANG, SIYI (OD)
Entity type:Individual
Prefix:DR
First Name:SIYI
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 VON KARMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2056
Mailing Address - Country:US
Mailing Address - Phone:498-547-4009
Mailing Address - Fax:
Practice Address - Street 1:4220 VON KARMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2056
Practice Address - Country:US
Practice Address - Phone:949-854-7400
Practice Address - Fax:498-547-3319
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35548-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty