Active NPI
Bolam Kim
- Periodontics
- Boston, MA
National Provider Identifier
1184857302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DL10750
- Practice address
- 100 E Newton St
G217
Boston, MA 02118-2308 - Phone
- (617) 680-9469
- NPI assigned
- Sep 3, 2009
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DL10750 | MA | Primary |
Addresses
Primary practice location
100 E Newton St
G217
Boston, MA 02118-2308
Mailing address
35 Northampton St
# 807
Boston, MA 02118-4014
Phone (617) 680-9469
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 |
|---|---|---|---|
| DL10750 | MA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251936000000",
"number": "1184857302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 NORTHAMPTON ST",
"address_2": "# 807",
"city": "BOSTON",
"state": "MA",
"postal_code": "021184014",
"telephone_number": "617-680-9469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E NEWTON ST",
"address_2": "G217",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182308",
"telephone_number": "617-680-9469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "BOLAM",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-03",
"last_updated": "2009-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "DL10750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.