Individual
JAE K KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 W WALNUT ST, CANTON, IL 61520-2444
(309) 647-5240
(309) 647-5104
Mailing address
7309 N KNOXVILLE AVE, SUITE 200, PEORIA, IL 61614-2085
(309) 691-6225
(309) 691-7635
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036056328
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036056328
—
IL
01
—
P00945642
RAILROAD MEDICARE PTAN
IL
Enumeration date
06/16/2006
Last updated
05/04/2015
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