Provider Demographics
NPI:1881914216
Name:KIM, PATRICIA (DPM)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COURTHOUSE LN STE 11
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1731
Mailing Address - Country:US
Mailing Address - Phone:978-441-9241
Mailing Address - Fax:978-970-0248
Practice Address - Street 1:4 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1728
Practice Address - Country:US
Practice Address - Phone:978-441-9241
Practice Address - Fax:978-970-0248
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211D00000X
MAMA2395213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric