Healthcare Provider Details

I. General information

NPI: 1982627816
Provider Name (Legal Business Name): JIN QI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WASHINGTON ST
WATERTOWN NY
13601-4066
US

IV. Provider business mailing address

445 FACTORY ST PO BOX 91
WATERTOWN NY
13601-2729
US

V. Phone/Fax

Practice location:
  • Phone: 315-785-5809
  • Fax: 315-785-8619
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number222578
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: