Provider Demographics
NPI:1225041445
Name:KIM, YOU S (MD)
Entity Type:Individual
Prefix:MRS
First Name:YOU
Middle Name:S
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 1:370 LARRY POWER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5194
Mailing Address - Country:US
Mailing Address - Phone:815-937-3515
Mailing Address - Fax:815-935-4916
Practice Address - Street 1:370 LARRY POWER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5194
Practice Address - Country:US
Practice Address - Phone:815-937-3515
Practice Address - Fax:815-935-4916
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062285Medicaid
IL4607575OtherBC/BS