Provider Demographics
NPI:1396194148
Name:JIANG, SYDNEY (MD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINGSHAN
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-966-1600
Mailing Address - Fax:765-962-9641
Practice Address - Street 1:1434 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1947
Practice Address - Country:US
Practice Address - Phone:765-966-1600
Practice Address - Fax:765-962-9641
Is Sole Proprietor?:No
Enumeration Date:2016-06-11
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143004207Y00000X
390200000X
IN01086456A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program