MEDICARE: DR. ZAYNA JAN DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	019.034949	IL

General Provider Information

NPI Number	:	1972201275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZAYNA JAN DDS

Provider Business Mailing Address
First Line	:	1365 35TH ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1417
Country	:	US
Telephone Number	:	630-765-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 VANCINA LN
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-9531
Country	:	US
Telephone Number	:	815-348-9617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	06/13/2024

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