Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036-056827 | IL |
NPI | 1114963881 |
---|---|
Provider Name | Moon Kim |
First Address | Oak Brook, IL 60523-2213 |
Second Address | Oak Brook, IL 60523-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 09/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-085093 | (05) | IL |
G541140 | (02) | IL |
L76293 | MEDICARE PIN FOR GROUP #645650 (01) | IL |