Provider Demographics
NPI:1447600697
Name:ZHAO, JOHNNY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-1048
Mailing Address - Country:US
Mailing Address - Phone:737-231-1855
Mailing Address - Fax:737-221-5662
Practice Address - Street 1:120 CHRIS KELLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5359
Practice Address - Country:US
Practice Address - Phone:737-231-1855
Practice Address - Fax:737-221-5662
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4079207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology