Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 37817 | TX |
NPI | 1023772175 |
---|---|
Provider Name | Dr. Xuefeng Zhao |
First Address | Philadelphia, PA 19103-4317 |
Second Address | Philadelphia, PA 19103-4317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2021 |
Last Update Date | 25/10/2021 |