Provider Demographics
NPI:1679524524
Name:KIM, TERESA S (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:S
Other - Last Name:RHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4801 W PETERSON AVE
Mailing Address - Street 2:SUITE #506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-777-5436
Mailing Address - Fax:773-777-7567
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-777-5437
Practice Address - Fax:773-777-7567
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099644208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics