Provider Demographics
NPI:1205602349
Name:XINYI TCM LLC
Entity type:Organization
Organization Name:XINYI TCM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XINYI
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:626-297-9864
Mailing Address - Street 1:331 SAINT NICHOLAS AVE # 1D
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2738
Mailing Address - Country:US
Mailing Address - Phone:626-297-9864
Mailing Address - Fax:
Practice Address - Street 1:331 SAINT NICHOLAS AVE # 1D
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2738
Practice Address - Country:US
Practice Address - Phone:626-297-9864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service