Healthcare Provider Details

I. General information

NPI: 1891924031
Provider Name (Legal Business Name): ZEYNEP YESIM KUCUK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2696
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4260
  • Fax: 617-642-7941
Mailing address:
  • Phone: 617-724-4260
  • Fax: 617-642-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number1024246
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: