Basic Information
| Provider Information | |||||||||
| NPI: | 1811484983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIANG | ||||||||
| FirstName: | YIRAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S. JACKSON STREET | ||||||||
| Address2: | ACB, 3RD FLOOR | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40202 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 S JACKSON ST | ||||||||
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| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028525666 | ||||||||
| FaxNumber: | 5028528980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2018 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.