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General NPI Number Information
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NPI Number | 1215723432
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Entity Type | Individual
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Provider Name | KIBRET YOHANNES MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/27/2025
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Provider Practice Location Address
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Address Line | 330 BROOKLINE AVE
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City | BOSTON
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State | MA
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Zip | 02215-5491
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Country | US
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Telephone | 617-667-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 6320 MILLWOOD CT
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City | SPRINGFIELD
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State | VA
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Zip | 22152-2840
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Country | US
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Telephone | 703-585-6663
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 3019506
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License Number State | MA
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