Provider Demographics
NPI:1255486981
Name:KIM, EUN HAN (MD)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:HAN
Last Name:KIM
Suffix:
Gender:M
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:P.O. BOX 372
Mailing Address - Street 2:C/O MASSACHUSETTS ANESTHESIA CORPORATION
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0372
Mailing Address - Country:US
Mailing Address - Phone:781-341-3966
Mailing Address - Fax:781-341-8269
Practice Address - Street 1:91 MONTVALLE AVE
Practice Address - Street 2:C/O MASSACHUSETTS ANESTHESIA CORP
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-341-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39914207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology