Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 036103662 | IL |
NPI | 1790748473 |
---|---|
Provider Name | Jennifer Shin Hae Kim |
First Address | Glenview, IL 60026-1324 |
Second Address | Glenview, IL 60026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 09/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036103662 | (05) | IL |
H40359 | (02) |