Provider Demographics
NPI:1033810601
Name:SOMI KIM DMD MD PLLC
Entity Type:Organization
Organization Name:SOMI KIM DMD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-687-1209
Mailing Address - Street 1:2 JUNIPER PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3534
Mailing Address - Country:US
Mailing Address - Phone:413-687-1209
Mailing Address - Fax:
Practice Address - Street 1:117 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2515
Practice Address - Country:US
Practice Address - Phone:413-687-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty