1417288903 NPI number — HEE JIN ESTHER KIM SCD, RD, LD

Table of content: HEE JIN ESTHER KIM SCD, RD, LD (NPI 1417288903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417288903 NPI number — HEE JIN ESTHER KIM SCD, RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
HEE JIN
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SCD, RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
ESTHER
Provider Other Middle Name:
H.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417288903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 WASHINGTON STREET
Provider Second Line Business Mailing Address:
SOUTH SHORE MEDICAL CENTER, INC
Provider Business Mailing Address City Name:
NORWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02061-9147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-878-5200
Provider Business Mailing Address Fax Number:
781-878-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
SOUTH SHORE MEDICAL CENTER, INC
Provider Business Practice Location Address City Name:
NORWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02061-9147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-878-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2010

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: 133N00000X , with the licence number:  136 , 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: 042297845 . This is a "MULTI-PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417288903 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "GREAT WEST HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: LD0323 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".