Provider Demographics
NPI:1831205194
Name:ABC PEDIATRICS OF KANKAKEE COUNTY
Entity type:Organization
Organization Name:ABC PEDIATRICS OF KANKAKEE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOU
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-937-3515
Mailing Address - Street 1:370 LARRY POWER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5193
Mailing Address - Country:US
Mailing Address - Phone:815-937-3515
Mailing Address - Fax:815-935-4916
Practice Address - Street 1:370 LARRY POWER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5194
Practice Address - Country:US
Practice Address - Phone:815-937-3515
Practice Address - Fax:815-935-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty