Healthcare Provider Details

I. General information

NPI: 1952868812
Provider Name (Legal Business Name): PETER ZIYAO ZHAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 KISSENA BLVD STE 117
FLUSHING NY
11355-3150
US

IV. Provider business mailing address

4125 KISSENA BLVD STE 117
FLUSHING NY
11355-3150
US

V. Phone/Fax

Practice location:
  • Phone: 718-321-9700
  • Fax:
Mailing address:
  • Phone: 718-321-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number061252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: