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General NPI Number Information
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NPI Number | 1124728431
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Entity Type | Individual
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Provider Name | CHRISTINE KIM
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 635 ALBANY ST
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City | BOSTON
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State | MA
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Zip | 02118-3550
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Country | US
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Telephone | 857-529-7348
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Fax |
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Provider Business Mailing Address
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Address Line | 193 CEDAR ST
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City | LEXINGTON
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State | MA
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Zip | 02421-6539
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Country | US
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Telephone | 339-234-2338
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DL100401
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License Number State | MA
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