Provider Demographics
NPI:1881031656
Name:KIM, STEPHANIE S (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3231 S. EUCLID AVENUE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:708-783-2000
Mailing Address - Fax:708-783-3656
Practice Address - Street 1:3231 S. EUCLID AVENUE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:708-783-2000
Practice Address - Fax:708-783-3656
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125062813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine