Provider Demographics
NPI:1215313937
Name:JIN, XING
Entity type:Individual
Prefix:
First Name:XING
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 162ND ST
Mailing Address - Street 2:FL 2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4126
Mailing Address - Country:US
Mailing Address - Phone:646-919-7725
Mailing Address - Fax:
Practice Address - Street 1:4233 162ND ST
Practice Address - Street 2:FL 2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4126
Practice Address - Country:US
Practice Address - Phone:646-919-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY933956286172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver