1003813536 NPI number — MARILYN S KIM M.D.

Table of content: MARILYN S KIM M.D. (NPI 1003813536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003813536 NPI number — MARILYN S KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
MARILYN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003813536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1177 BOSTON PROVIDENCE TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-329-1400
Provider Business Mailing Address Fax Number:
781-278-5667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1177 BOSTON PROVIDENCE TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062-5019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-329-1400
Provider Business Practice Location Address Fax Number:
781-278-5664
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  77523 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110145403 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 761489 . This is a "TUFTS BENEFIT ADMINISTRAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116047 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3118525 . This is a "MASS HEALTH DIV OF MED SV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 761489 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 761489 . This is a "TUFTS COMMONWEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 761489 . This is a "TUFTS TOTAL HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62131 . This is a "HARVARD PILGRIMPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0410132 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27576 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4877330 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62131 . This is a "HARVARD PILGRIM POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J14303 . This is a "BS BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: J14303 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62131 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: E72131 . This is a "FIRST SENIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4877330 . This is a "HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J14303 . This is a "HMO BLUE BLUE CHOICE" identifier . This identifiers is of the category "OTHER".




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