Provider Demographics
NPI:1891890695
Name:KIM, JAMES H (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1275 E. BELVIDERE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030
Mailing Address - Country:US
Mailing Address - Phone:847-548-2528
Mailing Address - Fax:847-548-2152
Practice Address - Street 1:1275 E. BELVIDERE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030
Practice Address - Country:US
Practice Address - Phone:847-548-2528
Practice Address - Fax:847-548-2152
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036050760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C25492Medicare UPIN
265730Medicare ID - Type Unspecified