# JAE KIM, M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710928627
- **Authorized official:** JAE K KIM M.D. (OWNER)
- **Authorized official phone:** (309) 671-8749

## Contact information

- **Practice address:** 210 W WALNUT ST, CANTON, IL 61520-2444
- **Practice address phone:** (309) 647-5240
- **Practice address fax:** (309) 647-5104
- **Mailing address:** 7309 N KNOXVILLE AVE, SUITE 200, PEORIA, IL 61614-2085
- **Mailing address phone:** (309) 691-6225
- **Mailing address fax:** (309) 691-7635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 036056328 | IL | Yes |

## Other

- **Enumeration date:** 06/10/2006
- **Last updated:** 05/01/2015