MEDICARE: REGINA Y KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	226532	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104906155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA Y KIM MD

Provider Business Mailing Address
First Line	:	MERCY WEST FALMOUTH PRIMARY CARE
Second Line	:	75 GRAY RD
City	:	FALMOUTH
State	:	ME
Zip	:	04105
Country	:	US
Telephone Number	:	207-535-1340
Fax Number	:	207-535-1358

Provider Business Practice Location Address
First Line	:	75 GRAY RD
Second Line	:
City	:	FALMOUTH
State	:	ME
Zip	:	04105-2010
Country	:	US
Telephone Number	:	207-535-1340
Fax Number	:	207-535-1358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	12/08/2017

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