Individual
STANLEY KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-2489
(630) 933-2827
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-2489
(630) 933-2827
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A71763
CA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036109828
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A717630
MEDI CAL
CA
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036109828
—
IL
01
—
3625139096019701
CDH HFS GROUP PAYEE ID
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
07/03/2006
Last updated
06/23/2014
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