Provider Demographics
NPI:1760561872
Name:RIM, CHONG SOO (MD)
Entity Type:Individual
Prefix:DR
First Name:CHONG
Middle Name:SOO
Last Name:RIM
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 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 740
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-275-4446
Mailing Address - Fax:
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 740
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-275-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36921508300OtherADVOCATE LUTHERAN NUMBER
IL21603473OtherBLUE SHIELD PROVIDER #
IL5039OtherADVOCATE LUTHERAN PIN
IL5039OtherADVOCATE LUTHERAN PIN
IL21603473OtherBLUE SHIELD PROVIDER #
IL36921508300OtherADVOCATE LUTHERAN NUMBER