Provider Demographics
NPI:1033355169
Name:MOO KIM, MD, PC
Entity type:Organization
Organization Name:MOO KIM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOO
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-794-4800
Mailing Address - Street 1:112 JACKSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5045
Mailing Address - Country:US
Mailing Address - Phone:978-794-4800
Mailing Address - Fax:978-794-4801
Practice Address - Street 1:112 JACKSON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5045
Practice Address - Country:US
Practice Address - Phone:978-794-4800
Practice Address - Fax:978-794-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60417261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain