Provider Demographics
NPI:1669272415
Name:ZHAO, JEFFREY SHAWN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SHAWN
Last Name:ZHAO
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 PAMPAS CIR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2070
Mailing Address - Country:US
Mailing Address - Phone:312-810-6965
Mailing Address - Fax:
Practice Address - Street 1:303 S GLENOAKS BLVD STE 12
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1184
Practice Address - Country:US
Practice Address - Phone:818-846-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1106181223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice