Active NPI
Yixin Jiang
- Dentist
- Providence, RI
National Provider Identifier
1124819255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN10000949
- Practice address
- 100 Mathewson St
Providence, RI 02903-1859 - Phone
- (617) 468-8210
- NPI assigned
- May 16, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN10000949 | MA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
100 Mathewson St
Providence, RI 02903-1859
Mailing address
1 Kneeland St
Boston, MA 02111-1527
Other practice location 1
1 Kneeland St
Boston, MA 02111-1527
Phone (617) 468-8210
Other practice location 2
243 Elmwood Ave
Providence, RI 02907-1547
Phone (401) 409-4553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN10000949 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780272000000",
"number": "1124819255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MATHEWSON ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029031859",
"telephone_number": "617-468-8210"
}
],
"practiceLocations": [
{
"address_1": "1 Kneeland St",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021111527",
"country_code": "US",
"telephone_number": "617-468-8210",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "243 Elmwood Ave",
"address_purpose": "LOCATION",
"city": "Providence",
"state": "RI",
"postal_code": "029071547",
"country_code": "US",
"telephone_number": "401-409-4553",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JIANG",
"first_name": "YIXIN",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2025-05-16",
"last_updated": "2026-06-01",
"certification_date": "2026-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN10000949",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.