Provider Demographics
NPI:1073386652
Name:ZHAO, JIAN
Entity Type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 LAKE UNDERHILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5090
Mailing Address - Country:US
Mailing Address - Phone:407-275-0002
Mailing Address - Fax:407-275-0072
Practice Address - Street 1:11325 LAKE UNDERHILL RD STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5090
Practice Address - Country:US
Practice Address - Phone:407-275-0002
Practice Address - Fax:407-275-0072
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74557207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology