Provider Demographics
NPI:1851445118
Name:KIM, YOUNG HEE (MS, RD, CNSD)
Entity Type:Individual
Prefix:
First Name:YOUNG HEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:NUTRITION DEPARTMENT
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2301
Mailing Address - Country:US
Mailing Address - Phone:413-748-9184
Mailing Address - Fax:413-736-1779
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:NUTRITION DEPARTMENT
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-748-9184
Practice Address - Fax:413-736-1779
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered