Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 036068846 | IL |
Y | 208000000X | Pediatrician | 036068846 | IL |
NPI | 1104932136 |
---|---|
Provider Name | Dr. Kyung S Kim |
First Address | Niles, IL 60714-1224 |
Second Address | Niles, IL 60714-1224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036068846 | (05) | IL |
E 18624 | (02) | IL |