Provider Demographics
NPI:1790748473
Name:KIM, JENNIFER SHIN HAE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHIN HAE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 PFINGSTEN RD STE 320
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1324
Mailing Address - Country:US
Mailing Address - Phone:847-998-4170
Mailing Address - Fax:847-998-4165
Practice Address - Street 1:2050 PFINGSTEN RD STE 320
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-998-4170
Practice Address - Fax:847-998-4165
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361036622080P0201X, 2080P0201X
NY2558302080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103662Medicaid
IL036103662Medicaid
H40359Medicare UPIN