Provider Demographics
NPI:1558647693
Name:DR. JANE KOU, PSYCHIATRIST, LLC
Entity Type:Organization
Organization Name:DR. JANE KOU, PSYCHIATRIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-421-7479
Mailing Address - Street 1:610 S SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3524
Mailing Address - Country:US
Mailing Address - Phone:315-421-7479
Mailing Address - Fax:315-473-9853
Practice Address - Street 1:610 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3524
Practice Address - Country:US
Practice Address - Phone:315-421-7479
Practice Address - Fax:315-473-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1635722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01377100Medicaid
NY52013BMedicare PIN