Provider Demographics
NPI:1073791794
Name:KIM, STEVE KWANGSUN
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:KWANGSUN
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SHERMAN AVE
Mailing Address - Street 2:201
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4465
Mailing Address - Country:US
Mailing Address - Phone:847-475-8639
Mailing Address - Fax:
Practice Address - Street 1:4034 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2825
Practice Address - Country:US
Practice Address - Phone:773-545-3279
Practice Address - Fax:773-545-6263
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2932231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist