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General NPI Number Information
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NPI Number | 1770078586
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Entity Type | Individual
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Provider Name | EUN EE KIM DO
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1000 HEALTH CENTER DR STE 401
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City | MATTOON
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State | IL
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Zip | 61938-4648
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Country | US
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Telephone | 217-258-4020
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Fax | 217-258-4023
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Provider Business Mailing Address
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Address Line | PO BOX 372
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City | MATTOON
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State | IL
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Zip | 61938-0372
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Country | US
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Telephone | 217-258-2581
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20A18048
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036171704
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License Number State | IL
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