Provider Demographics
NPI:1942341250
Name:KIM, LISA SUNHEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUNHEE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 DEMPSTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8427
Mailing Address - Country:US
Mailing Address - Phone:847-296-1200
Mailing Address - Fax:847-296-7913
Practice Address - Street 1:2604 DEMPSTER ST STE 300
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8427
Practice Address - Country:US
Practice Address - Phone:847-296-1200
Practice Address - Fax:847-296-7913
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL373580Medicare ID - Type Unspecified
ILL38417Medicare UPIN