Individual
MRS. SO J KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1044 N FRANCISCO AVE, CHICAGO, IL 60622-2743
(773) 292-8200
Mailing address
47 DEVONSHIRE DR, OAK BROOK, IL 60523-1712
(630) 887-0031
(630) 887-0031
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036-055406
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01638884
BLUE CROSS BLUE SHIELD
IL
05
—
036055406
—
IL
Enumeration date
08/25/2005
Last updated
07/21/2008
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