Healthcare Provider Details

I. General information

NPI: 1760979199
Provider Name (Legal Business Name): JESSICA XIN YING ZUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 CHESTNUT ST
PHILADELPHIA PA
19104-2612
US

IV. Provider business mailing address

3615 CHESTNUT ST
PHILADELPHIA PA
19104-2612
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2746
  • Fax:
Mailing address:
  • Phone: 215-662-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD481697
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: