MEDICARE: AINA MARIA KIM

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	183500000X	Pharmacist	PH239758	MA

General Provider Information

NPI Number	:	1972101756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AINA MARIA KIM

Provider Business Mailing Address
First Line	:	1890 COLUMBUS AVE
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-1047
Country	:	US
Telephone Number	:	617-445-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 COLUMBUS AVE
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-1047
Country	:	US
Telephone Number	:	617-445-5457
Fax Number	:

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

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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Directions to “ AINA MARIA KIM ” Practice Location

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