Healthcare Provider Details

I. General information

NPI: 1013583699
Provider Name (Legal Business Name): JI SOO KIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZIE KIL MD

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC1052
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-6686
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-0529
  • Fax:
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116035346
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMDR-8495
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036-175647
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: