Healthcare Provider Details

I. General information

NPI: 1760472310
Provider Name (Legal Business Name): JIN XU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14022 BEECH AVE STE 2A
FLUSHING NY
11355-2821
US

IV. Provider business mailing address

14022 BEECH AVE STE 2A
FLUSHING NY
11355-2821
US

V. Phone/Fax

Practice location:
  • Phone: 347-506-0512
  • Fax:
Mailing address:
  • Phone: 347-506-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number222051
License Number StateNY

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: