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General NPI Number Information
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NPI Number | 1053887042
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Entity Type | Individual
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Provider Name | HEEYOON KIM OD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 5630 DEMPSTER ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-3110
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Country | US
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Telephone | 847-581-1891
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Fax |
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Provider Business Mailing Address
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Address Line | 611 PRESTWICK LN
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City | WHEELING
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State | IL
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Zip | 60090-6233
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Country | US
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Telephone | 224-392-0855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046011257
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License Number State | IL
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