Provider Demographics
NPI:1881191849
Name:KIM, WOOHEON THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:WOOHEON
Middle Name:THOMAS
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 E. ERIE STREET
Mailing Address - Street 2:UNIT 1806
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-868-5278
Mailing Address - Fax:
Practice Address - Street 1:251 EAST HURON STREET (NORTHWESTERN MEMORIAL HOSPITAL)
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-12-19
Deactivation Date:2018-11-16
Deactivation Code:
Reactivation Date:2018-12-07
Provider Licenses
StateLicense IDTaxonomies
IL125071950207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program