Provider Demographics
NPI:1043208119
Name:KIM, SAECHIN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:SAECHIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5248
Mailing Address - Country:US
Mailing Address - Phone:617-734-7766
Mailing Address - Fax:617-734-3663
Practice Address - Street 1:1269 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5245
Practice Address - Country:US
Practice Address - Phone:617-734-7766
Practice Address - Fax:617-734-3663
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150934207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7878184OtherAETNA NON-HMO
MA3204804Medicaid
MA750056OtherTUFTS HEALTH PLANS
MA3552256OtherAETNA HMO
MAJ23064OtherBLUE CROSS BLUE SHIELD
MA09040162OtherUNITED HEALTH CARE
MAH09857Medicare UPIN
MAA30549Medicare ID - Type Unspecified