Provider Demographics
NPI:1215066162
Name:SOUTH SUBURBAN OBSTETRICS &
Entity type:Organization
Organization Name:SOUTH SUBURBAN OBSTETRICS &
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-687-7373
Mailing Address - Street 1:5320 159TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-4705
Mailing Address - Country:US
Mailing Address - Phone:708-687-7373
Mailing Address - Fax:
Practice Address - Street 1:5320 159TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-4705
Practice Address - Country:US
Practice Address - Phone:708-687-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12385Medicare UPIN
IL463980Medicare PIN