Provider Demographics
NPI:1104072529
Name:FOSTER, KIM LEAH (LAC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:LEAH
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COGSWELL AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2027
Mailing Address - Country:US
Mailing Address - Phone:617-230-1910
Mailing Address - Fax:
Practice Address - Street 1:53 LANGLEY RD STE 340
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1919
Practice Address - Country:US
Practice Address - Phone:617-230-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235317171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA235317OtherLICENSED ACUPUNCTURIST