Individual
ALLIS KIM
Active
Individual
ALLIS KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
157401
MA
207XX0801X
Orthopaedic Trauma Physician
157401
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000409533001
BS NENY
NY
05
—
02670579
—
NY
01
—
10100115
CDPHP
NY
01
—
658G61
EMPIRE BC
NY
01
—
7446715
AETNA
NY
01
—
790107
MVP
NY
Enumeration date
10/12/2006
Last updated
07/10/2012
Update your record
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