MEDICARE: DR. SUSAN LEE KIM DO

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	208M00000X	Hospitalist Physician	036122610	IL
2	261QP2300X	Primary Care Clinic/Center	036122610	IL
3	207R00000X	Internal Medicine Physician	036122610	IL

General Provider Information

NPI Number	:	1568643211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN LEE KIM DO

Provider Business Mailing Address
First Line	:	2601 COMPASS RD STE 135
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8077
Country	:	US
Telephone Number	:	224-255-5408
Fax Number	:	847-529-0319

Provider Business Practice Location Address
First Line	:	2601 COMPASS RD STE 135
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8077
Country	:	US
Telephone Number	:	224-255-5408
Fax Number	:	224-529-0319

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

Provider Enumeration Date	:	11/23/2007
Last Update Date	:	12/01/2023

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