Provider Demographics
NPI:1518204023
Name:HAO, JIANJUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIANJUN
Middle Name:
Last Name:HAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4121
Mailing Address - Country:US
Mailing Address - Phone:630-299-3403
Mailing Address - Fax:
Practice Address - Street 1:4370 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4121
Practice Address - Country:US
Practice Address - Phone:630-299-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-028943122300000X
IL021-0024501223X0400X
CT0106231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist