Provider Demographics
NPI:1376123752
Name:KIM, CAROLINE (DO)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1200 BROOKWOOD DR APT 354
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1451
Mailing Address - Country:US
Mailing Address - Phone:407-920-2971
Mailing Address - Fax:
Practice Address - Street 1:3700 W 203RD ST STE 301
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1182
Practice Address - Country:US
Practice Address - Phone:708-679-2850
Practice Address - Fax:708-503-3815
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036171732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine