Provider Demographics
NPI:1245453695
Name:KIM, DUK CHIN (MD)
Entity type:Individual
Prefix:DR
First Name:DUK
Middle Name:CHIN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 W LINCOLN ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1987
Mailing Address - Country:US
Mailing Address - Phone:618-233-0308
Mailing Address - Fax:618-233-7609
Practice Address - Street 1:300 W LINCOLN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1987
Practice Address - Country:US
Practice Address - Phone:618-233-0308
Practice Address - Fax:618-233-7609
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36050757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050757Medicaid
IL791112090AOtherRAIL ROAD MEDICARE
IL100692OtherHEALTHLINK
IL0008200412OtherBLUE SHIELD
IL371054015OtherCOMMERCIAL
IL100692OtherHEALTHLINK
ILC44804Medicare UPIN