Provider Demographics
NPI:1669472759
Name:KIM, THOMAS Y (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W GOLF RD
Mailing Address - Street 2:SUITE 68
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3929
Mailing Address - Country:US
Mailing Address - Phone:847-593-5511
Mailing Address - Fax:847-593-0872
Practice Address - Street 1:415 W GOLF RD
Practice Address - Street 2:SUITE 68
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3929
Practice Address - Country:US
Practice Address - Phone:847-593-5511
Practice Address - Fax:847-593-0872
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101858207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615125OtherBLUE SHIELD GROUP #
IL0607120001OtherCIGNA GROUP #
ILL77642Medicare PIN
ILCF4186Medicare ID - Type UnspecifiedRR MEDICARE GROUP #
ILG71675Medicare UPIN