Healthcare Provider Details

I. General information

NPI: 1225704257
Provider Name (Legal Business Name): JINBAO ZHAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SEASIDE AVE
MILFORD CT
06460-4603
US

IV. Provider business mailing address

18 BONAIR CIR
MILFORD CT
06461-2647
US

V. Phone/Fax

Practice location:
  • Phone: 203-301-1100
  • Fax:
Mailing address:
  • Phone: 203-218-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.009909
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: