Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD049272L | PA |
N | 208600000X | Surgeon | MD049272L | PA |
Y | 2082S0105X | Plastic Hand Surgeon | 78337 | MA |
NPI | 1992721724 |
---|---|
Provider Name | David C. Kim |
First Address | Worcester, MA 01608-1216 |
Second Address | Worcester, MA 01608-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 28/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110053618A | (05) | MA |