Healthcare Provider Details

I. General information

NPI: 1063943314
Provider Name (Legal Business Name): JESSE JUNCONG XIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 LOFTIS BLVD STE 201
NEWPORT NEWS VA
23606-2981
US

IV. Provider business mailing address

3000 COLISEUM DR
HAMPTON VA
23666-5963
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-9850
  • Fax:
Mailing address:
  • Phone: 757-736-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number320409
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101274650
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: