Healthcare Provider Details

I. General information

NPI: 1598293516
Provider Name (Legal Business Name): JAMES ZHONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 12/10/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 W PEORIA AVE
GLENDALE AZ
85302-1207
US

IV. Provider business mailing address

5929 W PEORIA AVE
GLENDALE AZ
85302-1207
US

V. Phone/Fax

Practice location:
  • Phone: 623-432-3386
  • Fax:
Mailing address:
  • Phone: 623-432-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10698
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13052
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD011728
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: