Individual
LISA JIYOUNG KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
830 HARRISON AVE, MOAKLEY, 3RD FLOOR, BOSTON, MA 02118
(617) 638-6428
(617) 638-5756
Mailing address
801 ALBANY STREET, FLOOR GROUND, BOSTON, MA 02119
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN2278996
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110146618A
—
MA
Enumeration date
06/15/2018
Last updated
02/17/2022
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