Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1215301106 |
---|---|
Provider Name | Kira Kim |
First Address | Lynn, MA 01902-3110 |
Second Address | Lynn, MA 01902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2015 |
Last Update Date | 14/05/2018 |