Healthcare Provider Details

I. General information

NPI: 1982082723
Provider Name (Legal Business Name): HKD OUTREACH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 BLUE HILL AVE
MATTAPAN MA
02126-1819
US

IV. Provider business mailing address

1192 BLUE HILL AVE
MATTAPAN MA
02126-1819
US

V. Phone/Fax

Practice location:
  • Phone: 617-201-1002
  • Fax: 844-564-1409
Mailing address:
  • Phone: 617-201-1002
  • Fax: 844-564-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116999
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number230791
License Number StateMA

VIII. Authorized Official

Name: ADAM BIED
Title or Position: OWNER
Credential: MD
Phone: 617-201-1002