MEDICARE: KAREN H 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	174400000X	Specialist	222632-1	NY
2	207N00000X	Dermatology Physician	228964	MA

General Provider Information

NPI Number	:	1215920004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN H KIM MD

Provider Business Mailing Address
First Line	:	1244 BOYLSTON ST.
Second Line	:	SUITE 302
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467
Country	:	US
Telephone Number	:	617-731-1600
Fax Number	:	617-731-1601

Provider Business Practice Location Address
First Line	:	1244 BOYLSTON ST
Second Line	:	SUITE 302
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467
Country	:	US
Telephone Number	:	617-731-1600
Fax Number	:	617-731-1601

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/05/2009

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