Provider Demographics
NPI:1366936189
Name:KIM, YI-HWA (MD)
Entity type:Individual
Prefix:
First Name:YI-HWA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YI HWA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:24600 W 127TH ST STE B100
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9511
Mailing Address - Country:US
Mailing Address - Phone:815-731-9000
Mailing Address - Fax:815-731-9001
Practice Address - Street 1:24600 W 127TH ST STE B100
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9511
Practice Address - Country:US
Practice Address - Phone:815-731-9000
Practice Address - Fax:815-731-9001
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036156995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine