Provider Demographics
NPI:1558591057
Name:KIM, CHRISTINE NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:NICOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1330 BOYLSTON STREET
Mailing Address - Street 2:SUITE 1019
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5528
Mailing Address - Country:US
Mailing Address - Phone:857-233-4486
Mailing Address - Fax:
Practice Address - Street 1:1330 BOYLSTON STREET
Practice Address - Street 2:SUITE 1019
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5528
Practice Address - Country:US
Practice Address - Phone:857-233-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist