Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036140043 | IL |
N | 208000000X | Pediatrician | 125062991 | IL |
NPI | 1003117334 |
---|---|
Provider Name | Christina Soojin Kim |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2010 |
Last Update Date | 12/06/2019 |