Provider Demographics
NPI:1043206030
Name:YIN, XI P (MD, PHD)
Entity Type:Individual
Prefix:
First Name:XI
Middle Name:P
Last Name:YIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 CANAL ST
Mailing Address - Street 2:2FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4536
Mailing Address - Country:US
Mailing Address - Phone:212-226-1161
Mailing Address - Fax:212-966-1354
Practice Address - Street 1:167 CANAL ST
Practice Address - Street 2:2FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4536
Practice Address - Country:US
Practice Address - Phone:212-226-1161
Practice Address - Fax:212-966-1354
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204134208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01717862Medicaid
65L301Medicare ID - Type Unspecified
G44155Medicare UPIN