Provider Demographics
NPI:1982112421
Name:MARIA KIM M.D. INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:MARIA KIM M.D. INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN - INTERNIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-868-9171
Mailing Address - Street 1:99 BJORKLUND AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 HUNTOON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ROCHDALE
Practice Address - State:MA
Practice Address - Zip Code:01542-1305
Practice Address - Country:US
Practice Address - Phone:508-892-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital