Healthcare Provider Details

I. General information

NPI: 1134062060
Provider Name (Legal Business Name): DONGHWAN KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S. WOOD STREET UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE, ROOM 1403,
CHICAGO IL
60612
US

IV. Provider business mailing address

820 S WOOD STREET (MC 675) SUITE 100 UNIVERSITY OF ILLINOIS COLLEGE OF ME
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-8297
  • Fax: 312-996-8204
Mailing address:
  • Phone: 312-996-2933
  • Fax: 312-996-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: