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Individual
JIYOUNG CHAE
Active
Individual
JIYOUNG CHAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28193970A
IN
363LP2300X
Primary Care Nurse Practitioner
Primary
71005808A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000964485
ANTHEM PROVIDER PIN NUMBER
IN
05
—
201323610
—
IN
Enumeration date
06/30/2015
Last updated
09/06/2017
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