Provider Demographics
NPI:1689025975
Name:ZHU, YIZHOU (DDS)
Entity type:Individual
Prefix:
First Name:YIZHOU
Middle Name:
Last Name:ZHU
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 1:1481 NW 13TH AVE APT 838
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3413
Mailing Address - Country:US
Mailing Address - Phone:626-823-7350
Mailing Address - Fax:
Practice Address - Street 1:13023 SE 84TH AVE STE A
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9798
Practice Address - Country:US
Practice Address - Phone:503-353-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60665299122300000X
ORD10833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist