Provider Demographics
NPI:1518453406
Name:KIM, JOSEPH UN (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:UN
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FENWOOD RD FL 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6128
Mailing Address - Country:US
Mailing Address - Phone:617-732-5355
Mailing Address - Fax:617-975-0930
Practice Address - Street 1:60 FENWOOD RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6128
Practice Address - Country:US
Practice Address - Phone:617-732-5355
Practice Address - Fax:617-975-0930
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10326005-2501103G00000X
MAPSY10000181103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist