Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 157401 | MA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 157401 | MA |
NPI | 1053400879 |
---|---|
Provider Name | Allis Kim |
First Address | Marlborough, MA 01752-1271 |
Second Address | Marlborough, MA 01752-1271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 10/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000409533001 | BS NENY (01) | NY |
02670579 | (05) | NY |
10100115 | CDPHP (01) | NY |
658G61 | EMPIRE BC (01) | NY |
7446715 | AETNA (01) | NY |
790107 | MVP (01) | NY |
G78007 | (02) |