Provider Demographics
NPI:1235117979
Name:TAN, XIN (MD)
Entity Type:Individual
Prefix:
First Name:XIN
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 COLDEN ST
Mailing Address - Street 2:SUITE L17
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4855
Mailing Address - Country:US
Mailing Address - Phone:718-661-4800
Mailing Address - Fax:718-888-2701
Practice Address - Street 1:4242 COLDEN ST
Practice Address - Street 2:SUITE L17
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4855
Practice Address - Country:US
Practice Address - Phone:718-661-4800
Practice Address - Fax:718-888-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY219846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02129591Medicaid
NY02129591Medicaid