Provider Demographics
NPI:1518970821
Name:KIM, JULIE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC, PEDIATRIC HEMATOLOGY/ONCOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-5541
Mailing Address - Fax:603-650-0591
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC, PEDIATRIC HEMATOLOGY/ONCOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5541
Practice Address - Fax:603-650-0591
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH131102080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012931Medicaid
NH30206181Medicaid
NH30206181Medicaid
I69142Medicare UPIN