MEDICARE: DR. JESSIE ZHU DMD MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	019.035677	IL

General Provider Information

NPI Number	:	1366253916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSIE ZHU DMD MS

Provider Business Mailing Address
First Line	:	1850 GREEN BAY RD # W303
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3136
Country	:	US
Telephone Number	:	859-433-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 S WAUKEGAN RD STE 101
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2672
Country	:	US
Telephone Number	:	847-615-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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