Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-143764 | IL |
N | 208600000X | Surgeon | 036-143764 | IL |
N | 208200000X | Surgeon | 52389 | TN |
N | 208600000X | Surgeon | 52389 | TN |
N | 2086S0102X | Surgical Critical Care | 036-143764 | IL |
N | 2086S0102X | Surgical Critical Care | 52389 | TN |
Y | 2086S0127X | Trauma Surgeon | 036-143764 | IL |
NPI | 1003045097 |
---|---|
Provider Name | Elijah Kim |
First Address | Memphis, TN 38138-3666 |
Second Address | Springfield, IL 62769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 04/11/2021 |