Individual
MARY KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
2424 W PETERSON AVE, CHICAGO, IL 60659-4100
(773) 761-0300
(773) 761-0300
Mailing address
500 PRESTWICK LN, WHEELING, IL 60090-6231
(847) 668-0125
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019031189
IL
122300000X
Dentist
34965
TX
1223G0001X
General Practice Dentistry
Primary
DN122544
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2017
Last updated
03/01/2022
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