Provider Demographics
NPI:1932114451
Name:DONG S KIM MD SC
Entity Type:Organization
Organization Name:DONG S KIM MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-933-3555
Mailing Address - Street 1:489 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4140
Mailing Address - Country:US
Mailing Address - Phone:847-933-3555
Mailing Address - Fax:847-933-3559
Practice Address - Street 1:9700 N KENTON AVE
Practice Address - Street 2:STE K202
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-933-3555
Practice Address - Fax:847-933-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626554OtherBS OF IL
IL036101382Medicaid
H24112Medicare UPIN
593930Medicare ID - Type Unspecified