MEDICARE: DR. DONG OUK KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician		IL

General Provider Information

NPI Number	:	1104938984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONG OUK KIM M.D.

Provider Business Mailing Address
First Line	:	400 N WALL ST
Second Line	:	SUITE 410
City	:	KANKAKEE
State	:	IL
Zip	:	60901-2940
Country	:	US
Telephone Number	:	815-933-2221
Fax Number	:	815-933-7363

Provider Business Practice Location Address
First Line	:	400 N WALL ST
Second Line	:	SUITE 410
City	:	KANKAKEE
State	:	IL
Zip	:	60901-2940
Country	:	US
Telephone Number	:	815-933-2221
Fax Number	:	815-933-7363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. DONG OUK KIM M.D.” Practice Location

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