Healthcare Provider Details

I. General information

NPI: 1205933355
Provider Name (Legal Business Name): SUNG SUP KIM M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE SUITE G 465
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE SUITE G 465
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-8700
  • Fax: 773-271-5912
Mailing address:
  • Phone: 773-271-8700
  • Fax: 773-271-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SUNG SUP KIM
Title or Position: OWNER
Credential: M.D.
Phone: 773-271-8700