Healthcare Provider Details

I. General information

NPI: 1184283715
Provider Name (Legal Business Name): DEREK ZHAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 AMBAUM BLVD SW
BURIEN WA
98166-1423
US

IV. Provider business mailing address

13404 NEWCASTLE COMMONS DR APT 329
NEWCASTLE WA
98059-3212
US

V. Phone/Fax

Practice location:
  • Phone: 206-246-4559
  • Fax:
Mailing address:
  • Phone: 206-913-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE.61157736
License Number StateWA
# 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: