| Hannah Kim Dds, Inc | |
|
895 E Grand Ave Unit 1 Lake Villa IL 60046-7883 | |
| (224) 444-8358 | |
| Not Available |
| Full Name | Hannah Kim Dds, Inc |
|---|---|
| Speciality | Dentist |
| Location | 895 E Grand Ave Unit 1, Lake Villa, Illinois |
| Authorized Official Name and Position | Hannah H Kim (PRESIDENT) |
| Authorized Official Contact | 2244448358 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hannah Kim Dds, Inc 895 E Grand Ave Unit 1 Lake Villa IL 60046-7883 Ph: (224) 444-8358 | Hannah Kim Dds, Inc 895 E Grand Ave Unit 1 Lake Villa IL 60046-7883 Ph: (224) 444-8358 |
| NPI Number | 1457803710 |
|---|---|
| Provider Enumeration Date | 11/02/2016 |
| Last Update Date | 11/02/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457803710 | NPI | - | NPPES |
| 166805 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019025464 (Illinois) | Primary |
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