Provider Demographics
NPI:1326576968
Name:KIM, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 BAY SCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1104
Mailing Address - Country:US
Mailing Address - Phone:630-357-5280
Mailing Address - Fax:630-357-5367
Practice Address - Street 1:1855 BAY SCOTT CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1104
Practice Address - Country:US
Practice Address - Phone:630-357-5280
Practice Address - Fax:630-357-5367
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172880207W00000X
390200000X
IL036.159289207W00000X
IL125.070941207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program