Individual
CHANG KWON KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,F.A.C.S.
Contact information
Practice address
0N300 ARMSTRONG LN, GENEVA, IL 60134-6081
(630) 208-1700
Mailing address
PO BOX 546, ST CHARLES, IL 60174-0546
(630) 208-1700
(630) 208-1707
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036060318
IL
2086S0129X
Vascular Surgery Physician
036060318
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060318
—
IL
Enumeration date
04/27/2006
Last updated
02/12/2013
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