Provider Demographics
NPI:1659451862
Name:JIN, XIAOCHUN (PHD)
Entity Type:Individual
Prefix:
First Name:XIAOCHUN
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 58TH ST
Mailing Address - Street 2:3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3609
Mailing Address - Country:US
Mailing Address - Phone:718-757-5345
Mailing Address - Fax:718-768-0114
Practice Address - Street 1:833 58TH ST
Practice Address - Street 2:3R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3609
Practice Address - Country:US
Practice Address - Phone:718-757-5345
Practice Address - Fax:718-768-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016093103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061994OtherVALUE OPTION
NYXIAOCHUN JINOtherBLUECROSS BLUESHIELD
NY02602679Medicaid
NYP3494218OtherOXFORD
NYXIAOCHUN JINOtherAETNA
NYN315491OtherWELLCARE
NYS16093-7BOtherWORKERS COMPENSATION
NYXIAOCHUN JINOtherGHI
NY01609368OtherHIP
NYXIAOCHUN JINOtherCIGNA
NY273396OtherHEALTH NET
NYVM6321Medicare ID - Type UnspecifiedMEDICARE
NY061994OtherVALUE OPTION