Provider Demographics
NPI:1245122126
Name:KIM, ISABELLA GRACE
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:GRACE
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S PRAIRIE AVE APT 1601
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3423
Mailing Address - Country:US
Mailing Address - Phone:224-213-8677
Mailing Address - Fax:
Practice Address - Street 1:1811 W NORTH AVE STE 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-0204
Practice Address - Country:US
Practice Address - Phone:312-819-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program