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General NPI Number Information
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NPI Number | 1851469936
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Entity Type | Organization
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Legal Business Name | PEACE MEDICAL CENTER, S.C.
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 14618 LINCOLN AVE
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City | HARVEY
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State | IL
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Zip | 60426-1610
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Country | US
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Telephone | 708-339-7000
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Fax | 708-339-7026
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Provider Business Mailing Address
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Address Line | PO BOX 6401
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City | AURORA
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State | IL
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Zip | 60598-0401
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Country | US
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Telephone | 312-498-2413
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEE HAN KIM
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Credential | M.D.
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Telephone | 773-947-7534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042618663
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License Number State | IL
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