Provider Demographics
NPI:1811939010
Name:KIM, YEONG H (MD)
Entity type:Individual
Prefix:
First Name:YEONG
Middle Name:H
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 1:455 S ROSELLE RD
Mailing Address - Street 2:#207
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2971
Mailing Address - Country:US
Mailing Address - Phone:847-301-1212
Mailing Address - Fax:847-301-1277
Practice Address - Street 1:455 S ROSELLE RD
Practice Address - Street 2:#207
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-2971
Practice Address - Country:US
Practice Address - Phone:847-301-1212
Practice Address - Fax:847-301-1277
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044777207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110067930OtherRAILROAD MEDICARE
IL036044777Medicaid
IL21603515OtherBLUE CROSS BLUE SHIELD
ILC41737Medicare UPIN
IL036044777Medicaid