Healthcare Provider Details

I. General information

NPI: 1619831666
Provider Name (Legal Business Name): CHENGLONG ZHAO DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BARRANCA PKWY STE 310
IRVINE CA
92604-4631
US

IV. Provider business mailing address

4950 BARRANCA PKWY STE 310
IRVINE CA
92604-4631
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-8547
  • Fax: 949-552-8540
Mailing address:
  • Phone: 949-552-8547
  • Fax: 949-552-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHENGLONG ZHAO
Title or Position: CEO
Credential: DDS
Phone: 909-264-0308