Provider Demographics
NPI:1215990080
Name:XU, JIN (MD)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 INGOT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510-9639
Mailing Address - Country:US
Mailing Address - Phone:610-944-8818
Mailing Address - Fax:
Practice Address - Street 1:224 WESTLAKE AVE N STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5260
Practice Address - Country:US
Practice Address - Phone:833-411-5469
Practice Address - Fax:855-459-3020
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61497115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1309024OtherBLUE SHIELD
PA7591692OtherAETNA
PA2002271000OtherKEYSTONE EAST
PA50038080OtherBLUE CROSS
PA7591692OtherAETNA
PA50038080OtherBLUE CROSS