Healthcare Provider Details

I. General information

NPI: 1417825886
Provider Name (Legal Business Name): ZIQING ZHAO BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10096 W FAIRVIEW AVE
BOISE ID
83704-5099
US

IV. Provider business mailing address

10096 W FAIRVIEW AVE
BOISE ID
83704-5099
US

V. Phone/Fax

Practice location:
  • Phone: 208-908-7882
  • Fax: 208-908-7883
Mailing address:
  • Phone: 208-908-7882
  • Fax: 208-908-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: