Provider Demographics
NPI:1861427577
Name:KIM, MOO K (MD)
Entity type:Individual
Prefix:
First Name:MOO
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOO
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:112 JACKSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5045
Mailing Address - Country:US
Mailing Address - Phone:978-794-4800
Mailing Address - Fax:978-794-4801
Practice Address - Street 1:112 JACKSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5045
Practice Address - Country:US
Practice Address - Phone:978-794-4800
Practice Address - Fax:978-794-4801
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60417208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110046074Medicaid
MA110046074Medicaid
MAJ07684Medicare ID - Type Unspecified