Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 277168 | MA |
Y | 208600000X | Surgeon | 277168 | MA |
NPI | 1003255951 |
---|---|
Provider Name | Victor Kim |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 06/12/2018 |