Provider Demographics
NPI:1568916658
Name:SHI, JIA XING
Entity Type:Individual
Prefix:
First Name:JIA XING
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 QUINT AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2519
Mailing Address - Country:US
Mailing Address - Phone:718-304-6862
Mailing Address - Fax:
Practice Address - Street 1:100 GEORGE P HASSETT DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3258
Practice Address - Country:US
Practice Address - Phone:781-393-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor