Active NPI
Chaewon Kim
- Pharmacist
- Revere, MA
National Provider Identifier
1124738026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH241248
- Practice address
- 467 Broadway
Revere, MA 02151-3030 - Phone
- (781) 289-8656
- NPI assigned
- Dec 1, 2022
- Last updated
- Dec 1, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH241248 | MA | Primary |
Addresses
Primary practice location
467 Broadway
Revere, MA 02151-3030
Mailing address
1 Longfellow PL Apt 2118
Boston, MA 02114-2419
Phone (857) 202-1280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH241248 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669852800000",
"number": "1124738026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 LONGFELLOW PL APT 2118",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142419",
"telephone_number": "857-202-1280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "467 BROADWAY",
"city": "REVERE",
"state": "MA",
"postal_code": "021513030",
"telephone_number": "781-289-8656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHAEWON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-01",
"last_updated": "2022-12-01",
"certification_date": "2022-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH241248",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Revere, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.