Healthcare Provider Details

I. General information

NPI: 1568091544
Provider Name (Legal Business Name): JOHNATHAN KARL ZHAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 S ELM AVE
FRESNO CA
93706-5435
US

IV. Provider business mailing address

2760 S ELM AVE
FRESNO CA
93706-5435
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5300
  • Fax: 559-457-5390
Mailing address:
  • Phone: 559-457-5300
  • Fax: 559-457-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA197011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: