Individual
DR. MARY GRACE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
8321 W GOLF RD, NILES, IL 60714-1113
(847) 720-3504
(847) 692-5271
Mailing address
2424 W. PETERSON, CHICAGO, IL 60659
(773) 761-0300
(773) 761-0009
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019029922
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019029922
—
IL
Enumeration date
07/29/2014
Last updated
12/02/2022
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