Healthcare Provider Details

I. General information

NPI: 1487744363
Provider Name (Legal Business Name): KYUNGYEE WELLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 LOWELL STREET
METHUEN MA
01844-3696
US

IV. Provider business mailing address

135 LOWELL STREET
METHUEN MA
01844-3696
US

V. Phone/Fax

Practice location:
  • Phone: 978-687-2119
  • Fax: 978-687-9688
Mailing address:
  • Phone: 978-687-2119
  • Fax: 978-687-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45741
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9904641
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerMEDICAID
# 2
Identifier9727094
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: