Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016005437 | IL |
Y | 222Z00000X | Podiatrist | 016005437 | IL |
N | 213EP1101X | Primary Podiatric Medicine | 016005437 | IL |
N | 111NR0200X | Radiology | 016005437 | IL |
N | 213ER0200X | Radiology | 016005437 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016005437 | IL |
NPI | 1770887408 |
---|---|
Provider Name | Dr. Sujin G Kim |
First Address | Rolling Meadows, IL 60008-2005 |
Second Address | Rolling Meadows, IL 60008-2005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 18/03/2021 |