Provider Demographics
NPI:1346202967
Name:AMIN, KIM S (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:S
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:333 SCHOOL ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5334
Mailing Address - Country:US
Mailing Address - Phone:401-724-6070
Mailing Address - Fax:401-726-0920
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:SUITE 215
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5334
Practice Address - Country:US
Practice Address - Phone:401-724-6070
Practice Address - Fax:401-726-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2015-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI6019173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001138Medicaid
RI9001138Medicaid
RID66113Medicare UPIN