Xiao Hong Jin MD PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

XIAO HONG JIN MD PLLC

Doing business as

Xiao Hong Jin MD

Practice address

15 Goodrich Ave
Petersburg, VA 23805-2119

Phone

(804) 732-0618

Fax

(804) 861-6846

NPI assigned

May 31, 2016

Last updated

Jan 30, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Xiao Hong Jin, MD

Title

Medical Director

Phone

(804) 732-0618

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Xiao Hong Jin MD Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Xiao Hong Jin, MD

  • Family Medicine Physician
  • Petersburg, VA
  • NPI 1679766752
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1467800599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11619 RIVERBOAT DR",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238365438",
            "telephone_number": "804-943-3695",
            "fax_number": "804-861-6846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 GOODRICH AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052119",
            "telephone_number": "804-732-0618",
            "fax_number": "804-861-6846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XIAO HONG JIN MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "JIN",
        "authorized_official_first_name": "XIAO HONG",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "804-732-0618",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679766752",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Xiao Hong Jin MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Wood, FNP-BC
• Imoni Malika Patrice Woodberry, LPC
• Altamarie Woods
• Rebecca Maxine Wyatt, CADC, CCJP, CSC
• Brenda C Wyche, LPC
• Fontellia Yates, RPH
• Sujatha Yellinedi, M.D.
• Ferley Terrell Yerby
• Yeshua Professional Counseling LLC
• Your Journey Care Connection LLC

• Primary Care Clinic/Center in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Primary Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.