Healthcare Provider Details

I. General information

NPI: 1144904384
Provider Name (Legal Business Name): ZI LIANG HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 CLARKSON RD
CHESTERFIELD MO
63017-4979
US

IV. Provider business mailing address

8025 BONHOMME AVE APT 1006
CLAYTON MO
63105-3546
US

V. Phone/Fax

Practice location:
  • Phone: 636-778-2333
  • Fax:
Mailing address:
  • Phone: 661-706-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2026015672
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: