Healthcare Provider Details

I. General information

NPI: 1275174310
Provider Name (Legal Business Name): YIGE ZHAO DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9840 CARMEL MOUNTAIN RD
SAN DIEGO CA
92129-2812
US

IV. Provider business mailing address

PO BOX 920050
DALLAS TX
75392-0050
US

V. Phone/Fax

Practice location:
  • Phone: 858-240-9953
  • Fax: 858-366-4211
Mailing address:
  • Phone: 714-845-8500
  • Fax: 303-952-0892

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: DR. YIGE ZHAO
Title or Position: OWNER
Credential: DDS
Phone: 858-240-9953