Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 036-109449 | IL |
NPI | 1124014642 |
---|---|
Provider Name | Sue Kim |
First Address | Chicago, IL 60678-1354 |
Second Address | Glenview, IL 60026-5805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-109449 | (05) | IL |