Provider Demographics
NPI:1417270653
Name:KIM, HUGH
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BOYLSTON ST
Mailing Address - Street 2:APT. # 1019
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4229
Mailing Address - Country:US
Mailing Address - Phone:857-233-4486
Mailing Address - Fax:
Practice Address - Street 1:1330 BOYLSTON ST
Practice Address - Street 2:APT. # 1019
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4229
Practice Address - Country:US
Practice Address - Phone:857-233-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18553271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics