1558688184 NPI number — JUNQING XIN MD

Table of content: JUNQING XIN MD (NPI 1558688184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558688184 NPI number — JUNQING XIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
XIN
Provider First Name:
JUNQING
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558688184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 EXCELSIOR BLVD
Provider Second Line Business Mailing Address:
METHODIST HOSPITALIST PROGRAM SUITE 2-260
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-993-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 EXCELSIOR BLVD
Provider Second Line Business Practice Location Address:
METHODIST HOSPITALIST PROGRAM SUITE 2-260
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-4702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-993-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  56457 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)