Healthcare Provider Details

I. General information

NPI: 1497042246
Provider Name (Legal Business Name): SHARON XIAO YING JIN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CHESTNUT ST
NEEDHAM MA
02492-2578
US

IV. Provider business mailing address

70 LONGFELLOW RD
NEWTON MA
02462-1508
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-6650
  • Fax:
Mailing address:
  • Phone: 585-935-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN1855694
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: