Provider Demographics
NPI:1407854797
Name:KIM, ALICE YANG-HEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:YANG-HEE
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 1:111 BREWSTER STREET
Mailing Address - Street 2:WOOD BLDG #516
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-3481
Mailing Address - Fax:401-729-2721
Practice Address - Street 1:111 BREWSTER STREET
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2262
Practice Address - Fax:401-729-3050
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227785207RC0000X
RIMD13512207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088547AMedicaid
NC02376341Medicaid
RIAK83696Medicaid
RI002028701OtherMEDICARE PTAN
RIAK83696Medicaid
MA110088547AMedicaid
NYH83323Medicare UPIN