Provider Demographics
NPI:1134657026
Name:KIM, SOOJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SOOJIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E. CHICAGO AVENUE, BOX 24
Mailing Address - Street 2:ANN AND ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-227-6340
Mailing Address - Fax:312-227-9412
Practice Address - Street 1:225 E. CHICAGO AVENUE, BOX 24
Practice Address - Street 2:ANN AND ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-227-6340
Practice Address - Fax:312-227-9412
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2018-01-10
Deactivation Date:2017-12-28
Deactivation Code:
Reactivation Date:2018-01-10
Provider Licenses
StateLicense IDTaxonomies
IL036142400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology