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Il Bong Kim

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NPI Number Detailed Information

Provider Information:

Name: Il Bong Kim
Gender: M
Provider License Number If Given:

NPI Information:

NPI: 1548269061
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 151 W HIGH ST
Morris, IL 60450
Phone Number: 8159425474
Fax Number: 8159425498

Provider Business Practice Location Address:

Address: 151 W HIGH ST
Morris, IL 60450
Phone Number: 8159425474
Fax Number: 8159425498

Provider Taxonomy:

Primary: 208600000X
Secondary (if any):
State: IL

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