Provider Demographics
NPI:1548547797
Name:KIM, GRACE SEUNGHEE (LICAC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:SEUNGHEE
Last Name:KIM
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:SEUNGHEE
Other - Middle Name:
Other - Last Name:PAEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICAC
Mailing Address - Street 1:442 MARRETT RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7749
Mailing Address - Country:US
Mailing Address - Phone:781-861-0560
Mailing Address - Fax:781-810-8799
Practice Address - Street 1:442 MARRETT RD STE 6
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7749
Practice Address - Country:US
Practice Address - Phone:781-861-0560
Practice Address - Fax:781-810-8799
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist