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General NPI Number Information
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NPI Number | 1114005683
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Entity Type | Individual
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Provider Name | KIM JOHN KAISER
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 37 CARDINAL RD
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City | EAST LYME
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State | CT
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Zip | 06333-1045
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Country | US
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Telephone | 860-691-3033
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Fax | 860-691-3006
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Provider Business Mailing Address
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Address Line | 37 CARDINAL RD
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City | EAST LYME
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State | CT
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Zip | 06333-1045
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Country | US
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Telephone | 860-691-3033
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Fax | 860-691-3006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 06-1357833
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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