Basic Information
| Provider Information | |||||||||
| NPI: | 1538377791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JING | ||||||||
| FirstName: | XI LIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1068 CRESTHAVEN RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018668525 | ||||||||
| FaxNumber: | 9013022525 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157073933 | ||||||||
| FaxNumber: | 2157072531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2007 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | MD 54232 | TN | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | MD447118 | PA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 03054279 | 05 | MS | MEDICAID | Q024671 | 05 | TN | MEDICAID | 003182131A | 05 | GA | MEDICAID | 1538377791 | 05 | MO | MEDICAID | 220206001 | 05 | AR | MEDICAID |