Provider Demographics
NPI:1548280605
Name:KIM, GEORGE C (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:3213
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2512
Mailing Address - Fax:847-570-1696
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:SUITE 3213
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2512
Practice Address - Fax:847-570-1696
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036099773207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1760001Medicare PIN
ILIL1759001Medicare PIN
IL1752001Medicare PIN
H37992Medicare UPIN