Provider Demographics
NPI:1629636113
Name:KIM, TESIA G (MD, MSED)
Entity type:Individual
Prefix:DR
First Name:TESIA
Middle Name:G
Last Name:KIM
Suffix:
Gender:F
Credentials:MD, MSED
Other - Prefix:DR
Other - First Name:TESIA
Other - Middle Name:G
Other - Last Name:KOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MSED
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:781-487-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA280426207V00000X
MA1013664207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology