Healthcare Provider Details

I. General information

NPI: 1598930471
Provider Name (Legal Business Name): YONGDONG ZHAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE, M/S MA7.110
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE M.A. 7.110
SEATTLE WA
98105-2601
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2057
  • Fax: 206-987-5060
Mailing address:
  • Phone: 206-987-2057
  • Fax: 206-987-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60329823
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD443409
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26318
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberMD60329823
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: