Individual
IL H. KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
15264
WV
208000000X
Pediatrics Physician
Primary
35.050817
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006612
ANTHEM BCBS
WV
01
—
000000007508
ANTHEM BCBS
—
01
—
000000181964
UNISON MEDICAID
OH
01
—
001714043
MOUNTAIN STATE BCBS
—
05
—
0112618000
—
WV
01
—
0556161
MOLINA MEDICAID
OH
05
—
0556161
—
OH
01
—
310917085107
CARESOURCE MEDICAID
OH
01
—
370002076
RR MEDICARE
—
Enumeration date
05/31/2006
Last updated
01/21/2021
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