Susan Kim, DMD
Individual provider Active NPI General Practice Dentistry · Malden, MA
NPI 1972689784 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972689784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 21549 (MA)
- Practice address
- 225 Centre St
Malden, MA 02148-5524 - Phone
- (781) 324-3200
- NPI assigned
- Oct 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21549 | MA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 42 North Dental Care, LLC | Past | Accepting new patients | |
| 42 North Dental Care, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21549 | MA | Yes |
Addresses
Primary practice location
225 Centre St
Malden, MA 02148-5524
Mailing address
156 Langdon St
Newton, MA 02458-2516
Other providers in Malden, MA
- Jennifer Kiger
- Rose Kilbride
- Amanda Grace Kilburn
- Hakseong Kim
- Ji-Hyun Kim
- Kindmind Crossroads & Counseling, LLC
- Ashley Cristina Augustus King
- Amy Kinyon
- Michael P Kippenberger
- Victoria Klappert
All providers in Malden, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.