Healthcare Provider Details

I. General information

NPI: 1255954467
Provider Name (Legal Business Name): YINJIE ZHAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 E MAIN ST
BRIDGEPORT CT
06608-1913
US

IV. Provider business mailing address

170 AMSTERDAM AVE APT 8J
NEW YORK NY
10023-5056
US

V. Phone/Fax

Practice location:
  • Phone: 203-616-4987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12993
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: