MEDICARE: HUIYUAN JIANG M.D.

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	208000000X	Pediatrics Physician	35094003	OH
2	208000000X	Pediatrics Physician	4301078886	MI
3	2084E0001X	Epilepsy Physician	C170408	CA
4	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	4301078886	MI
5	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	35094003	OH
6	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	C170408	CA

General Provider Information

NPI Number	:	1891718243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUIYUAN JIANG M.D.

Provider Business Mailing Address
First Line	:	9300 VALLEY CHILDRENS PL # SC05
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93636-8761
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12500 STOCKDALE HWY
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93314-9649
Country	:	US
Telephone Number	:	661-564-3300
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/19/2022

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