Form Health Associates Ma, P.C.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

FORM HEALTH ASSOCIATES MA, P.C.

Practice address

109 State St.
5TH FL
Boston, MA 02109-2906

Phone

(617) 505-1520

Fax

(617) 928-8401

NPI assigned

Oct 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nam Ho Kim

Title

President

Phone

(617) 505-1520

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1295554137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 STATE ST.",
            "address_2": "5TH FL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092906",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 STATE ST.",
            "address_2": "5TH FL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092906",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM HEALTH ASSOCIATES MA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-08",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "NAM",
        "authorized_official_middle_name": "HO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-505-1520"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Forkel
• Glynn K Forkey, LCSW
• Shannon Nicole Forlivio, PA-C
• Steven Forlivio, PA
• Form Behavioral Health Services PA
• Form Health Associates Ma, P.C.
• Form Psychiatry PLLC
• Alexandra Beth Forman, MD
• Ellen Forman
• John P Forman, MD

• Endocrinology, Diabetes & Metabolism Physician in Boston, MA
• Providers in Boston, MA by specialty
• Endocrinology, Diabetes & Metabolism Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.