Active NPI
San Kim
- Student in an Organized Health Care Education/Training Program
- Boston, MA
National Provider Identifier
1912684978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 3020128
- Practice address
- 55 Fruit St
Boston, MA 02114-2696 - Phone
- (617) 726-8707
- NPI assigned
- Jun 30, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 3020128 | MA | Primary |
Addresses
Primary practice location
55 Fruit St
Boston, MA 02114-2696
Mailing address
55 Fruit St
Yawkey Center 2-2C
Boston, MA 02114-2696
Phone (216) 476-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230718003586 | OH | Order and Referring Only - Internal Medicine | 8224498514 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57.255234 | OH | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783296000000",
"number": "1912684978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 FRUIT ST",
"address_2": "YAWKEY CENTER 2-2C",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142696",
"telephone_number": "216-476-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 FRUIT ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142696",
"telephone_number": "617-726-8707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-30",
"last_updated": "2026-07-06",
"certification_date": "2026-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": "3020128",
"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 Jul 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.