Provider Demographics
NPI:1144680596
Name:SANJIN MEDICAL PA
Entity type:Organization
Organization Name:SANJIN MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-220-9115
Mailing Address - Street 1:3300 N MAIN ST STE D
Mailing Address - Street 2:PMB 171
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4128
Mailing Address - Country:US
Mailing Address - Phone:864-220-9115
Mailing Address - Fax:864-220-9513
Practice Address - Street 1:102 COMMONS BLVD
Practice Address - Street 2:STE C
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7766
Practice Address - Country:US
Practice Address - Phone:864-220-9115
Practice Address - Fax:864-220-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17523103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty