Active NPI
Li Jin
- Anatomic Pathology & Clinical Pathology Physician
- Grand Blanc, MI
National Provider Identifier
1922121102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 4301102186
- Practice address
- 9460 S Saginaw Rd Ste D
Grand Blanc, MI 48439-8207 - Phone
- (810) 733-7741
- NPI assigned
- Apr 10, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Laboratory Director (Non-physician) | 247ZC0005X | 25MA06996600 | NJ | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 4301102186 | MI | Primary |
Addresses
Primary practice location
9460 S Saginaw Rd Ste D
Grand Blanc, MI 48439-8207
Mailing address
9460 S Saginaw Rd Ste D
Grand Blanc, MI 48439-8207
Phone (810) 733-7741
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922121102 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA06996600 | NJ | MD | Clinical Laboratory Director (Non-physician) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695081600000",
"number": "1922121102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9460 S SAGINAW RD STE D",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398207",
"telephone_number": "810-733-7741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9460 S SAGINAW RD STE D",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398207",
"telephone_number": "810-733-7741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIN",
"first_name": "LI",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2023-09-19",
"certification_date": "2023-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "247ZC0005X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
"state": "NJ",
"license": "25MA06996600",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MI",
"license": "4301102186",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1922121102",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Blanc, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.