Healthcare Provider Details

I. General information

NPI: 1326576968
Provider Name (Legal Business Name): ERIC KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 BAY SCOTT CIR
NAPERVILLE IL
60540-1104
US

IV. Provider business mailing address

1855 BAY SCOTT CIR
NAPERVILLE IL
60540-1104
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-5280
  • Fax: 630-357-5367
Mailing address:
  • Phone: 630-357-5280
  • Fax: 630-357-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA172880
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.159289
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125.070941
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: