Provider Demographics
NPI:1093738205
Name:KIM, YONG J (MD)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 REMINGTON BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3721
Mailing Address - Country:US
Mailing Address - Phone:630-759-2966
Mailing Address - Fax:630-759-6977
Practice Address - Street 1:396 REMINGTON BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4920
Practice Address - Country:US
Practice Address - Phone:630-759-2966
Practice Address - Fax:630-759-6977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL3646679207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046679Medicaid
D89227Medicare UPIN
IL473121001Medicare PIN