Provider Demographics
NPI:1568713824
Name:KIM, AI MARY HOSHINO (MA)
Entity Type:Individual
Prefix:
First Name:AI
Middle Name:MARY HOSHINO
Last Name:KIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AI
Other - Middle Name:MARY
Other - Last Name:HOSHINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:241 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3044
Mailing Address - Country:US
Mailing Address - Phone:847-636-6470
Mailing Address - Fax:
Practice Address - Street 1:241 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3044
Practice Address - Country:US
Practice Address - Phone:847-636-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010119235Z00000X
CA15584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist