Provider Demographics
NPI:1336632868
Name:EUNICE KIM, PSY.D., P.C.
Entity Type:Organization
Organization Name:EUNICE KIM, PSY.D., P.C.
Other - Org Name:EUNICE KIM, PSY.D., LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-398-7431
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1519
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3675
Mailing Address - Country:US
Mailing Address - Phone:773-398-7431
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1519
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3675
Practice Address - Country:US
Practice Address - Phone:773-398-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-09
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006918261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1326473943OtherBCBSIL