Provider Demographics
NPI:1932196219
Name:BAI, GRACE SOO KYUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:SOO KYUNG
Last Name:BAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:#409
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-933-0800
Mailing Address - Fax:855-329-4224
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:#409
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-933-0800
Practice Address - Fax:855-329-4224
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103366207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633731OtherBCBS
IL036103366Medicaid
IL036103366Medicaid
K01786Medicare ID - Type Unspecified