Kim, Tae Won

Kim, Tae Won is an individual health care provider with primary practice located at 355 Ridge Ave , Evanston IL 60202-3328. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Kim, Tae Won can be contacted via phone (847) 316-6101.

Contact Information

Primary practice address
355 Ridge Ave Evanston IL 60202-3328
Phone: (847) 316-6101
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 036054630 Illinois

Profile Details

NPI number 1932148632
LBN Legal business name Kim, Tae Won
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Sep 25th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932148632 NPPES
Illinois Other 01615776 BCBS PROVIDER NUMBER
Illinois MEDICAID 036054630 BCBS PROVIDER NUMBER
Illinois Other P01113996 BCBS PROVIDER NUMBER

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