Basic Information
| Provider Information | |||||||||
| NPI: | 1467871160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIANG | ||||||||
| FirstName: | VIVIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1022 DEPOT HILL RD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800201068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034652323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1022 DEPOT HILL RD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800201068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034652323 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 09/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR0062773 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101262156 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.