Individual
JENNIFER KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, SURGERY, SHREVEPORT, LA 71103-4228
(318) 675-2655
Mailing address
8600 N STATE ROUTE 91, PEORIA, IL 61615-9541
(309) 691-4005
(309) 691-6144
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036153868
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/27/2015
Last updated
09/09/2020
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