Provider Demographics
NPI:1891851622
Name:KIM, HEE H (MD)
Entity Type:Individual
Prefix:
First Name:HEE
Middle Name:H
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 1:34 RAMSGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1420
Mailing Address - Country:US
Mailing Address - Phone:708-361-0808
Mailing Address - Fax:
Practice Address - Street 1:7531 S STONY ISLAND AVE
Practice Address - Street 2:SUITE 153
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:773-947-7534
Practice Address - Fax:773-947-7761
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054891Medicaid
IL618521Medicare ID - Type Unspecified
IL036054891Medicaid