Provider Demographics
NPI:1447258736
Name:KIM, JEAN JIHI (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:JIHI
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 FRANKLIN ST
Mailing Address - Street 2:STE 203
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6265
Mailing Address - Country:US
Mailing Address - Phone:508-879-4407
Mailing Address - Fax:508-620-9395
Practice Address - Street 1:475 FRANKLIN ST
Practice Address - Street 2:STE 203
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6265
Practice Address - Country:US
Practice Address - Phone:508-879-4407
Practice Address - Fax:508-620-9395
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA155016208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3169464Medicaid
G49650Medicare UPIN
MA3169464Medicaid
MAA2269901Medicare PIN