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Individual

JIYOUNG CHAE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
Mailing address
PO BOX 5777, MARYVILLE, TN 37802-5777
(865) 246-2104
(865) 246-2106

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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