Individual
DR. TAE WON KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
355 RIDGE AVE, EVANSTON, IL 60202-3328
(847) 316-6101
Mailing address
355 RIDGE AVE, EVANSTON, IL 60202-3328
(847) 316-6101
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036054630
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615776
BCBS PROVIDER NUMBER
IL
05
—
036054630
—
IL
01
—
P01113996
RRMC
IL
Enumeration date
06/06/2006
Last updated
09/25/2013
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