Provider Demographics
NPI:1720275001
Name:KIM KOBUS PC
Entity Type:Organization
Organization Name:KIM KOBUS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-585-3988
Mailing Address - Street 1:PO BOX 6219
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-6219
Mailing Address - Country:US
Mailing Address - Phone:630-585-3988
Mailing Address - Fax:
Practice Address - Street 1:1240 IROQUOIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8536
Practice Address - Country:US
Practice Address - Phone:630-585-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232935OtherBC/BS ID