Provider Demographics
NPI:1366681421
Name:KIM, S THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:THERESA
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:706 W HUNTINGTON COMMONS RD
Mailing Address - Street 2:#1A
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5159
Mailing Address - Country:US
Mailing Address - Phone:847-387-0911
Mailing Address - Fax:773-878-7221
Practice Address - Street 1:5875 N LINCOLN AVE
Practice Address - Street 2:SUITE 131
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4672
Practice Address - Country:US
Practice Address - Phone:773-878-7222
Practice Address - Fax:773-878-7221
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01059631A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice