Healthcare Provider Details

I. General information

NPI: 1891718243
Provider Name (Legal Business Name): HUIYUAN JIANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 STOCKDALE HWY
BAKERSFIELD CA
93314-9649
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL # SC05
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 661-564-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35094003
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301078886
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberC170408
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number4301078886
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35094003
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberC170408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: