Provider Demographics
NPI:1538234216
Name:KIM, KI-IL (MD)
Entity type:Individual
Prefix:DR
First Name:KI-IL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KI-IL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5 WORTHEN PL
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2847
Mailing Address - Country:US
Mailing Address - Phone:978-475-0731
Mailing Address - Fax:978-475-0731
Practice Address - Street 1:5 WORTHEN PL
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2847
Practice Address - Country:US
Practice Address - Phone:978-475-0731
Practice Address - Fax:978-475-0731
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40621207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology