Provider Demographics
NPI:1437200292
Name:KIM, HELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HELLEN
Middle Name:
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:PO BOX 569
Mailing Address - Street 2:333 POMFRET STREET
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-0569
Mailing Address - Country:US
Mailing Address - Phone:860-963-2056
Mailing Address - Fax:860-928-6738
Practice Address - Street 1:333 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1852
Practice Address - Country:US
Practice Address - Phone:860-963-2056
Practice Address - Fax:860-928-6738
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0365822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001365825Medicaid
CTG2126Medicare UPIN
CT130000488Medicare ID - Type Unspecified