Provider Demographics
NPI:1871256792
Name:KIM, JAMES YUG (APN-CNP MSN-ED)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:YUG
Last Name:KIM
Suffix:
Gender:M
Credentials:APN-CNP MSN-ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N WESTMORELAND RD # LEVEL1
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:847-534-3278
Mailing Address - Fax:847-535-8590
Practice Address - Street 1:1000 N WESTMORELAND RD # LEVEL1
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-534-3278
Practice Address - Fax:847-535-8590
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041406091363L00000X
IL209024302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner