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General NPI Number Information
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NPI Number | 1447497904
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Entity Type | Organization
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Legal Business Name | TIFFANI KIM INSTITUTE, LLC
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 310 W SUPERIOR ST 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60654-3426
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Country | US
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Telephone | 312-260-9000
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Fax | 312-260-9096
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Provider Business Mailing Address
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Address Line | 310 W SUPERIOR ST 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60654-3426
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Country | US
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Telephone | 312-260-9000
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Fax | 312-260-9096
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SANDRA SCHMIDT
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Credential |
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Telephone | 312-260-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036037987
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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