Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | LP02029 | RI |
N | 111NI0900X | Internist | LP02029 | RI |
N | 207RH0000X | Hematologist | MD21420 | ME |
Y | 207RX0202X | Medical Oncology | MD21420 | ME |
NPI | 1124330675 |
---|---|
Provider Name | Byung Moon Kim |
First Address | Augusta, ME 04330-8160 |
Second Address | Augusta, ME 04330-8160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 20/06/2017 |