Basic Information
| Provider Information | |||||||||
| NPI: | 1538322417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | TAE | ||||||||
| MiddleName: | HYONG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 271 CAREW ST | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137489000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 69 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010629621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1345884118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 252023 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 242653 | MA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.