Provider Demographics
NPI:1831491299
Name:RIM, JAE RYUNG (MD)
Entity Type:Individual
Prefix:
First Name:JAE RYUNG
Middle Name:
Last Name:RIM
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 1:2141 IROQUOIS RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1472
Mailing Address - Country:US
Mailing Address - Phone:847-757-5510
Mailing Address - Fax:773-275-1610
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:773-275-4447
Practice Address - Fax:773-275-1610
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13285Medicare UPIN