Provider Demographics
NPI:1720236565
Name:JIANG, HAOYUAN (PHD, LAC)
Entity Type:Individual
Prefix:
First Name:HAOYUAN
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N MADISON AVE STE H
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4049
Mailing Address - Country:US
Mailing Address - Phone:317-946-6767
Mailing Address - Fax:
Practice Address - Street 1:520 N MADISON AVE STE H
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4049
Practice Address - Country:US
Practice Address - Phone:317-946-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000102A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist