Healthcare Provider Details

I. General information

NPI: 1821554619
Provider Name (Legal Business Name): ANNIE ZHAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 ROCKVILLE PIKE STE 200
ROCKVILLE MD
20852-1669
US

IV. Provider business mailing address

157 86TH ST
BROOKLYN NY
11209-4913
US

V. Phone/Fax

Practice location:
  • Phone: 240-503-8778
  • Fax:
Mailing address:
  • Phone: 917-750-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17361
License Number StateMD
# 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: