Provider Demographics
NPI:1083962138
Name:KIM, PEICHEN JESSIE (PT, ATP-SMS)
Entity Type:Individual
Prefix:
First Name:PEICHEN
Middle Name:JESSIE
Last Name:KIM
Suffix:
Gender:F
Credentials:PT, ATP-SMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9454 TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3908
Mailing Address - Country:US
Mailing Address - Phone:847-612-3769
Mailing Address - Fax:
Practice Address - Street 1:1401 S CALIFORNIA AVE
Practice Address - Street 2:ROOM 1701
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1858
Practice Address - Country:US
Practice Address - Phone:773-522-2010
Practice Address - Fax:773-522-6422
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist