Healthcare Provider Details

I. General information

NPI: 1598695504
Provider Name (Legal Business Name): LAUREN JIHYUN SIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 W 111TH ST
WORTH IL
60482-1636
US

IV. Provider business mailing address

6430 W 111TH ST
WORTH IL
60482-1636
US

V. Phone/Fax

Practice location:
  • Phone: 708-448-2540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number051308411
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: