Provider Demographics
NPI:1740472596
Name:KIM, KEE CHONG (MD)
Entity type:Individual
Prefix:DR
First Name:KEE
Middle Name:CHONG
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 1:500 SAUK PATH
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2775
Mailing Address - Country:US
Mailing Address - Phone:708-299-4932
Mailing Address - Fax:630-655-1548
Practice Address - Street 1:500 SAUK PATH
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2775
Practice Address - Country:US
Practice Address - Phone:708-299-4932
Practice Address - Fax:630-655-1548
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-056398207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD 13784Medicare UPIN
IL602310Medicare PIN