Provider Demographics
NPI:1215964804
Name:KIM, JENNIFER R (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GARDEN ST
Mailing Address - Street 2:UNIT 9
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3728
Mailing Address - Country:US
Mailing Address - Phone:857-205-5737
Mailing Address - Fax:
Practice Address - Street 1:9 RIVERSIDE RD
Practice Address - Street 2:HEALTH ADVANCES, LLC
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2281
Practice Address - Country:US
Practice Address - Phone:781-647-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics