Provider Demographics
NPI:1225257009
Name:KIM ANESTHESIOLOGISTS, P.C.
Entity Type:Organization
Organization Name:KIM ANESTHESIOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KILJUNG
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-356-5381
Mailing Address - Street 1:PO BOX 597903
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-7903
Mailing Address - Country:US
Mailing Address - Phone:815-941-1317
Mailing Address - Fax:815-941-1421
Practice Address - Street 1:8012 S CRANDON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1124
Practice Address - Country:US
Practice Address - Phone:773-356-5381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047946207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047946Medicaid
IL1626751OtherBLUE CROSS BLUE SHIELD
IL036047946Medicaid