Provider Demographics
NPI:1851305049
Name:KIM, JULIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 TABOR HILL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-2906
Mailing Address - Country:US
Mailing Address - Phone:617-510-6779
Mailing Address - Fax:781-314-7666
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:781-314-7600
Practice Address - Fax:781-314-7666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214157208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2013584Medicaid
MAA35383Medicare ID - Type Unspecified
MAH85103Medicare UPIN