Provider Demographics
NPI:1407818990
Name:KIM, MIN KWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:KWAN
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 1:1572 MAPLE AVE
Mailing Address - Street 2:APT 401
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4328
Mailing Address - Country:US
Mailing Address - Phone:619-534-1242
Mailing Address - Fax:
Practice Address - Street 1:3001 6TH ST
Practice Address - Street 2:SPECIALTY MEDICINE-CARDIOLOGY
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3210
Practice Address - Country:US
Practice Address - Phone:847-688-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055659A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine