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General NPI Number Information
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NPI Number | 1174939607
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Entity Type | Individual
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Provider Name | DR. MINJI KIM
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Gender | Female
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Dates
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Enumeration Date | 07/04/2014
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 505 WASHINGTON ST
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City | QUINCY
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State | MA
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Zip | 02169-5834
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Country | US
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Telephone | 617-639-5942
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Fax |
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Provider Business Mailing Address
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Address Line | 51 N BROADWAY
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City | NYACK
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State | NY
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Zip | 10960-2643
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Country | US
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Telephone | 845-358-5110
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 1856604
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License Number State | MA
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