Basic Information
| Provider Information | |||||||||
| NPI: | 1417288903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HEE JIN | ||||||||
| MiddleName: | ESTHER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | SCD, RD, LD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KIM | ||||||||
| OtherFirstName: | ESTHER | ||||||||
| OtherMiddleName: | H. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 75 WASHINGTON STREET | ||||||||
| Address2: | SOUTH SHORE MEDICAL CENTER, INC | ||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020619147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7818782650 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 WASHINGTON STREET | ||||||||
| Address2: | SOUTH SHORE MEDICAL CENTER, INC | ||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020619147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2010 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 136 | MA | Y | Dietary & Nutritional Service Providers | Nutritionist |
ID Information
| ID | Type | State | Issuer | Description | 042297845 | 01 | MULTI-PLAN | OTHER | 1417288903 | 01 | FALLON | OTHER | 042297845 | 01 | GREAT WEST HEALTH CARE | OTHER | LD0323 | 01 | MA | BCBSMA | OTHER |