Provider Demographics
NPI:1790946127
Name:KIM-GAVINO, CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:KIM-GAVINO
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 1:737 W WASHINGTON BLVD
Mailing Address - Street 2:#1807
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2173
Mailing Address - Country:US
Mailing Address - Phone:312-804-4504
Mailing Address - Fax:
Practice Address - Street 1:664 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3717
Practice Address - Country:US
Practice Address - Phone:312-335-1155
Practice Address - Fax:312-335-9098
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361203892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology