Individual
DR. KILJUNG KENNETH KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8012 S CRANDON AVE, CHICAGO, IL 60617-1124
(773) 356-5381
(773) 356-5186
Mailing address
PO BOX 597903, CHICAGO, IL 60659-7903
(815) 941-1317
(815) 941-1421
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036047946
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036047946
—
IL
01
—
1626751
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/22/2006
Last updated
10/28/2014
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