Provider Demographics
NPI:1851469936
Name:PEACE MEDICAL CENTER, S.C.
Entity Type:Organization
Organization Name:PEACE MEDICAL CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEE
Authorized Official - Middle Name:HAN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-947-7534
Mailing Address - Street 1:PO BOX 6401
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60598-0401
Mailing Address - Country:US
Mailing Address - Phone:312-498-2413
Mailing Address - Fax:
Practice Address - Street 1:14618 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-1610
Practice Address - Country:US
Practice Address - Phone:708-339-7000
Practice Address - Fax:708-339-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636003OtherBLUECROSS BLUESHIELD
IL01636003OtherBLUECROSS BLUESHIELD