Provider Demographics
NPI:1407083488
Name:KIM, THOMAS OUYJUUNG (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:OUYJUUNG
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:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01903-0626
Mailing Address - Country:US
Mailing Address - Phone:781-581-3900
Mailing Address - Fax:781-598-1050
Practice Address - Street 1:5359 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1450
Practice Address - Country:US
Practice Address - Phone:773-836-2785
Practice Address - Fax:773-836-7381
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241080207Q00000X
IL036143911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine