Provider Demographics
NPI:1487825139
Name:CHANDARANA, JYOTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTIN
Middle Name:
Last Name:CHANDARANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1071
Mailing Address - Country:US
Mailing Address - Phone:606-487-8059
Mailing Address - Fax:606-487-1658
Practice Address - Street 1:755 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9469
Practice Address - Country:US
Practice Address - Phone:606-436-5769
Practice Address - Fax:606-436-0601
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30439207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64304397Medicaid
KY64304397Medicaid
KY0680101Medicare PIN