1881914216 NPI number — DR. PATRICIA KIM DPM

Table of content: DR. PATRICIA KIM DPM (NPI 1881914216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881914216 NPI number — DR. PATRICIA KIM DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1881914216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 COURTHOUSE LN STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01824-1731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-441-9241
Provider Business Mailing Address Fax Number:
978-970-0248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 COURTHOUSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-441-9241
Provider Business Practice Location Address Fax Number:
978-970-0248
Provider Enumeration Date:
06/08/2010

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: 211D00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: MA2395 , 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)