Provider Demographics
NPI:1346435112
Name:KIM, JASON YUNGSUP (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:YUNGSUP
Last Name:KIM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:340 ILLINOIS STREET
Mailing Address - Street 2:USS TRANQUILLITY MEDICAL CLINIC 1007
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-5230
Mailing Address - Country:US
Mailing Address - Phone:847-688-6755
Mailing Address - Fax:847-688-7425
Practice Address - Street 1:3420 ILLINOIS ST
Practice Address - Street 2:USS TRANQUILLITY CLINIC 1007
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3161
Practice Address - Country:US
Practice Address - Phone:847-688-6755
Practice Address - Fax:847-688-6179
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2010-07-26
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Provider Licenses
StateLicense IDTaxonomies
MI4301038461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine