Provider Demographics
NPI:1083926950
Name:KIM, SOMI (DMD, MD)
Entity type:Individual
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First Name:SOMI
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD, MD
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Other - Last Name:
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Mailing Address - Street 1:2 JUNIPER PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3534
Mailing Address - Country:US
Mailing Address - Phone:781-671-0001
Mailing Address - Fax:781-995-0001
Practice Address - Street 1:117 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2515
Practice Address - Country:US
Practice Address - Phone:781-671-0001
Practice Address - Fax:781-995-0001
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MADN1857089204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery