Provider Demographics
NPI:1104906155
Name:KIM, REGINA Y (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MERCY WEST FALMOUTH PRIMARY CARE
Mailing Address - Street 2:75 GRAY RD
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105
Mailing Address - Country:US
Mailing Address - Phone:207-535-1340
Mailing Address - Fax:207-535-1358
Practice Address - Street 1:75 GRAY RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2010
Practice Address - Country:US
Practice Address - Phone:207-535-1340
Practice Address - Fax:207-535-1358
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02462628Medicaid
NYH19107Medicare UPIN
NY02462628Medicaid