MEDICARE: DR. KEWA JIANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		IN
2	2080A0000X	Pediatric Adolescent Medicine Physician	01094353A	IN

General Provider Information

NPI Number	:	1720666712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEWA JIANG MD

Provider Business Mailing Address
First Line	:	410 W 10TH ST STE 1001
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3011
Country	:	US
Telephone Number	:	317-274-8812
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W 10TH ST STE 1001
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3011
Country	:	US
Telephone Number	:	317-274-8812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	07/22/2024

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Directions to “ DR. KEWA JIANG MD” Practice Location

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