Provider Demographics
NPI:1013034461
Name:KIM, JEANIE CHUNG (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JEANIE
Middle Name:CHUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JEANIE
Other - Middle Name:YUN
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:308 ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1612
Mailing Address - Country:US
Mailing Address - Phone:847-573-1937
Mailing Address - Fax:
Practice Address - Street 1:150 W HALF DAY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:847-955-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist