Provider Demographics
NPI:1932309994
Name:ZHAO, SHIRLEY JING YU (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JING YU
Last Name:ZHAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:JING YU
Other - Last Name:ZHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1540 N TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2903
Mailing Address - Country:US
Mailing Address - Phone:415-810-2302
Mailing Address - Fax:
Practice Address - Street 1:1540 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2903
Practice Address - Country:US
Practice Address - Phone:415-810-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist