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General NPI Number Information
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NPI Number | 1124738026
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Entity Type | Individual
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Provider Name | CHAEWON KIM
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Gender | Female
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 467 BROADWAY
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City | REVERE
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State | MA
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Zip | 02151-3030
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Country | US
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Telephone | 781-289-8656
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Fax |
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Provider Business Mailing Address
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Address Line | 1 LONGFELLOW PL APT 2118
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City | BOSTON
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State | MA
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Zip | 02114-2419
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Country | US
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Telephone | 857-202-1280
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH241248
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License Number State | MA
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