Healthcare Provider Details

I. General information

NPI: 1184618209
Provider Name (Legal Business Name): JOON WOO KIM, M.D., SC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HOFFNER DRIVE
GRAYSLAKE IL
60030
US

IV. Provider business mailing address

925 HOFFNER DRIVE
GRAYSLAKE IL
60030
US

V. Phone/Fax

Practice location:
  • Phone: 847-223-6330
  • Fax:
Mailing address:
  • Phone: 847-223-6330
  • Fax: 847-223-6382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036088083
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOON WOO KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-223-6330