Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036059924 | IL |
NPI | 1013364421 |
---|---|
Provider Name | Kyung Sook Kim |
First Address | Savoy, IL 61874-9761 |
Second Address | Savoy, IL 61874-9761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 16/05/2016 |