Provider Demographics
NPI:1952312035
Name:SHIM, KI CASEY (MD)
Entity type:Individual
Prefix:DR
First Name:KI
Middle Name:CASEY
Last Name:SHIM
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 1:3447 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5116
Mailing Address - Country:US
Mailing Address - Phone:773-478-9250
Mailing Address - Fax:773-478-4363
Practice Address - Street 1:3447 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5116
Practice Address - Country:US
Practice Address - Phone:773-478-9250
Practice Address - Fax:773-478-4363
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
687090Medicare ID - Type Unspecified
D14895Medicare UPIN