Provider Demographics
NPI:1699086397
Name:CHIN, KIMBERLY Y (LIC AC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:Y
Last Name:CHIN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2871
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-1571
Mailing Address - Country:US
Mailing Address - Phone:781-435-1871
Mailing Address - Fax:
Practice Address - Street 1:105 MARBLE STREET
Practice Address - Street 2:APT 7
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-435-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216156171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist