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NPI Code Detail

MEDICARE: MOON SOO KIM MD

MEDICARE: MOON SOO KIM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician25MA12768900NJ
2207R00000XInternal Medicine Physician293972MA

General Provider Information

NPI Number : 1104552124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOON SOO KIM MD
Provider Business Mailing Address
First Line : 115 LINCOLN ST
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01702-6358
Country : US
Telephone Number : 508-383-1000
Fax Number :
Provider Business Practice Location Address
First Line : 115 LINCOLN ST
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01702-6358
Country : US
Telephone Number : 508-383-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2022
Last Update Date : 04/06/2026

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Directions to “ MOON SOO KIM MD” Practice Location

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