Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 208965 | MA |
NPI | 1093790180 |
---|---|
Provider Name | Dr. Dennis H Kim |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2005 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2005646 | (05) | MA |
322568 | TUFTS HEALTH PLAN (01) | MA |
H84637 | (02) | |
J25980 | BCBS MA (01) | MA |