=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003047267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAELENE D KENNEDY KIM MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2009
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 351 DELNOR DR STE 400
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134-4228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-668-0833
-----------------------------------------------------
Fax | 630-208-4373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 351 DELNOR DR STE 400
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134-4228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-668-0833
-----------------------------------------------------
Fax | 630-208-4373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0102X
-----------------------------------------------------
Taxonomy Name | Surgical Critical Care Physician
-----------------------------------------------------
License Number | 036-148573
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0127X
-----------------------------------------------------
Taxonomy Name | Trauma Surgery Physician
-----------------------------------------------------
License Number | 036148573
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 036-148573
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------