Provider Demographics
NPI:1467800599
Name:XIAO HONG JIN MD PLLC
Entity Type:Organization
Organization Name:XIAO HONG JIN MD PLLC
Other - Org Name:XIAO HONG JIN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:XIAO HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-732-0618
Mailing Address - Street 1:11619 RIVERBOAT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-5438
Mailing Address - Country:US
Mailing Address - Phone:804-943-3695
Mailing Address - Fax:804-861-6846
Practice Address - Street 1:15 GOODRICH AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2119
Practice Address - Country:US
Practice Address - Phone:804-732-0618
Practice Address - Fax:804-861-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679766752Medicaid