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General NPI Number Information
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NPI Number | 1780047076
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Entity Type | Individual
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Provider Name | TAE KIM MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 757 PARK AVE W STE 2850
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2558
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Country | US
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Telephone | 847-570-1700
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Fax | 224-251-5470
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE STE 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone | 847-570-2040
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Fax | 847-570-5315
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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 | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 036157530
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License Number State | IL
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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 | 036157530
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License Number State | IL
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