MEDICARE: KELLY ZHAO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1760182422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY ZHAO PLLC

Provider Business Mailing Address
First Line	:	4210 ELLA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-4210
Country	:	US
Telephone Number	:	832-353-3838
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 ELLA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-4210
Country	:	US
Telephone Number	:	832-353-3838
Fax Number	:

Authorized Official
Title or Position	:	DR.
Name	:	KELLY ZHAO
Credential	:
Telephone Number	:	832-353-3838

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	03/09/2023

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Directions to “KELLY ZHAO PLLC ” Practice Location

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