Healthcare Provider Details

I. General information

NPI: 1043831894
Provider Name (Legal Business Name): INAE JANG KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INAE ESTHER JANG

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W 95TH ST
OAK LAWN IL
60453-3888
US

IV. Provider business mailing address

2321 S WABASH AVE APT 9
CHICAGO IL
60616-4828
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-9393
  • Fax: 708-636-2022
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.075774
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number036170383
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3360170383
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.075774
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number036170383
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: