Organization
SUNG SUP KIM M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUNG SUP KIM M.D. (OWNER)
(773) 271-8700
Entity
Organization
Contact information
Practice address
5140 N CALIFORNIA AVE, SUITE G 465, CHICAGO, IL 60625-3645
(773) 271-8700
(773) 271-5912
Mailing address
5140 N CALIFORNIA AVE, SUITE G 465, CHICAGO, IL 60625-3645
(773) 271-8700
(773) 271-5912
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31604584
BCBS
IL
01
—
DF8696
RAILROAD MEDICARE PTAN#
—
Enumeration date
09/20/2006
Last updated
01/02/2008
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