Provider Demographics
NPI:1558459172
Name:KIM, CHOONG GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:CHOONG
Middle Name:GILBERT
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GILBERT
Other - Middle Name:C
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:925 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 W 22ND ST
Practice Address - Street 2:SUITE 610
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2006
Practice Address - Country:US
Practice Address - Phone:630-537-1720
Practice Address - Fax:630-537-1724
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046962207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046962Medicaid
ILL88770Medicare PIN
ILK36590Medicare PIN
D89221Medicare UPIN