Provider Demographics
NPI:1265786057
Name:LIN, XIAO LI (PA)
Entity type:Individual
Prefix:MISS
First Name:XIAO
Middle Name:LI
Last Name:LIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19622 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1311
Mailing Address - Country:US
Mailing Address - Phone:917-595-6887
Mailing Address - Fax:
Practice Address - Street 1:8791 193RD ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1440
Practice Address - Country:US
Practice Address - Phone:718-740-5440
Practice Address - Fax:718-740-5447
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016195363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical