Individual ProviderGlen M KimInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address15 Francis Street, Pbb-B-428, Boston, MA 02115(617) 278-0055PECOS EnrollmentThis provider is enrolled in PECOS as GLEN KIM.Based on the most recent information from CMS, provider Glen M Kim is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1619983053Provider TypeIndividualFull NameKim, Glen MCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date7/31/2006Last Updated8/12/2014Contact InformationPractice LocationPractice Address15 Francis Street, Pbb-B-428, Boston, MA 02115Phone(617) 278-0055FaxUnlisted FaxMailing LocationMailing Address15 Francis Street, Pbb-B-428, Boston, MA 02115Phone(617) 278-0055FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense210722Massachusetts