Provider Demographics
NPI:1770993255
Name:KIM, AILEEN (MD)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418837
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2231
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-7615
Practice Address - Street 1:30077 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3101
Practice Address - Country:US
Practice Address - Phone:301-884-2508
Practice Address - Fax:301-884-2476
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD00878332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty