Provider Demographics
NPI:1417288903
Name:KIM, HEE JIN ESTHER (SCD, RD, LD)
Entity Type:Individual
Prefix:
First Name:HEE JIN
Middle Name:ESTHER
Last Name:KIM
Suffix:
Gender:F
Credentials:SCD, RD, LD
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:H
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON STREET
Mailing Address - Street 2:SOUTH SHORE MEDICAL CENTER, INC
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-9147
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-2650
Practice Address - Street 1:75 WASHINGTON STREET
Practice Address - Street 2:SOUTH SHORE MEDICAL CENTER, INC
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-9147
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA136133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherMULTI-PLAN
1417288903OtherFALLON
042297845OtherGREAT WEST HEALTH CARE
MALD0323OtherBCBSMA