Provider Demographics
NPI:1609099076
Name:DUK C KIM MD LTD
Entity Type:Organization
Organization Name:DUK C KIM MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUK
Authorized Official - Middle Name:CHIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-233-0308
Mailing Address - Street 1:300 W LINCOLN ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1987
Mailing Address - Country:US
Mailing Address - Phone:618-233-0308
Mailing Address - Fax:618-233-7609
Practice Address - Street 1:300 W LINCOLN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1987
Practice Address - Country:US
Practice Address - Phone:618-233-0308
Practice Address - Fax:618-233-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36050757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008200412OtherBLUE SHIELD
IL100692OtherHEALTHLINK
IL=========OtherCOMMERCIAL
IL231592Medicare ID - Type UnspecifiedMEDICARE
IL100692OtherHEALTHLINK