Provider Demographics
NPI:1912123084
Name:SAECHIN KIM, MD, LLC
Entity Type:Organization
Organization Name:SAECHIN KIM, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAECHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:617-734-7766
Mailing Address - Street 1:1269 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5245
Mailing Address - Country:US
Mailing Address - Phone:617-734-7766
Mailing Address - Fax:
Practice Address - Street 1:1269 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5245
Practice Address - Country:US
Practice Address - Phone:617-734-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150934207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18784OtherBLUE CROSS BLUE SHIELD MA
MA9734830Medicaid
MA9734830Medicaid