Provider Demographics
NPI:1811063423
Name:KIM, BYOUNG O (MD)
Entity type:Individual
Prefix:DR
First Name:BYOUNG
Middle Name:O
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:454 W BOUGHTON
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1378
Mailing Address - Country:US
Mailing Address - Phone:630-759-0088
Mailing Address - Fax:630-759-4505
Practice Address - Street 1:454 W BOUGHTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1378
Practice Address - Country:US
Practice Address - Phone:630-759-0088
Practice Address - Fax:630-759-4505
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10264Medicare UPIN
248410Medicare ID - Type Unspecified