Provider Demographics
NPI:1194743112
Name:KIM, BRENDA Y (DO)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:767 PARK AVE W
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2400
Mailing Address - Country:US
Mailing Address - Phone:847-432-1558
Mailing Address - Fax:847-432-6981
Practice Address - Street 1:767 PARK AVE W
Practice Address - Street 2:SUITE 240
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2400
Practice Address - Country:US
Practice Address - Phone:847-432-1558
Practice Address - Fax:847-432-6981
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-113574207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113574Medicaid
IL036113574Medicaid
ILI51443Medicare UPIN