Provider Demographics
NPI:1104932136
Name:KIM, KYUNG S (MD)
Entity type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KYUNG
Other - Middle Name:S
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:241 GOLF MILL CTR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1224
Mailing Address - Country:US
Mailing Address - Phone:847-375-8090
Mailing Address - Fax:847-375-8108
Practice Address - Street 1:241 GOLF MILL CTR
Practice Address - Street 2:SUITE 202
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1224
Practice Address - Country:US
Practice Address - Phone:847-375-8090
Practice Address - Fax:847-375-8108
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068846208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068846Medicaid
ILE 18624Medicare UPIN