Healthcare Provider Details

I. General information

NPI: 1811763386
Provider Name (Legal Business Name): JENNIFER ZHOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S WABASH AVE
CHICAGO IL
60605-2412
US

IV. Provider business mailing address

1500 SHERMAN AVE APT 719
EVANSTON IL
60201-4540
US

V. Phone/Fax

Practice location:
  • Phone: 978-855-1715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019035983
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: