Healthcare Provider Details

I. General information

NPI: 1104932136
Provider Name (Legal Business Name): KYUNG S KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYUNG S KIM M.D.

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 GOLF MILL CTR SUITE 202
NILES IL
60714-1224
US

IV. Provider business mailing address

241 GOLF MILL CTR SUITE 202
NILES IL
60714-1224
US

V. Phone/Fax

Practice location:
  • Phone: 847-375-8090
  • Fax: 847-375-8108
Mailing address:
  • Phone: 847-375-8090
  • Fax: 847-375-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036068846
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036068846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: