Provider Demographics
NPI:1902939432
Name:YIN, XIAOSHUANG (MD)
Entity Type:Individual
Prefix:DR
First Name:XIAOSHUANG
Middle Name:
Last Name:YIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:XIAOSHUANG
Other - Middle Name:NANCY
Other - Last Name:YIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:630 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-342-5155
Mailing Address - Fax:
Practice Address - Street 1:122 E 76TH ST STE 1A1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2833
Practice Address - Country:US
Practice Address - Phone:212-434-4130
Practice Address - Fax:212-434-4919
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21113501207R00000X
NY211135207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH06687Medicare UPIN