Basic Information
| Provider Information | |||||||||
| NPI: | 1093912131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | SEUNG-HO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 ENGAMORE LN | ||||||||
| Address2: | APT. 107 | ||||||||
| City: | NORWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020622508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812695857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020623487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812786260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 231985 | MA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.