Individual
DR. PU WOONG KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD SC
Contact information
Practice address
5140 N CALIFORNIA, SUITE 715, CHICAGO, IL 60625
(773) 561-1554
(773) 561-1586
Mailing address
5140 N CALIFORNIA, SUITE 715, CHICAGO, IL 60625
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21625149
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/11/2006
Last updated
03/07/2023
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