Provider Demographics
NPI:1740263045
Name:NG, KIMMIE (MD)
Entity type:Individual
Prefix:DR
First Name:KIMMIE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:D1220
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-4150
Mailing Address - Fax:617-632-5370
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:D1220
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-4150
Practice Address - Fax:617-632-5370
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA223906207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine