Provider Demographics
NPI:1053535591
Name:PEDIATRIC MEDICAL SERVICES
Entity type:Organization
Organization Name:PEDIATRIC MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-4730
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:STE 403
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-674-4730
Mailing Address - Fax:847-674-4732
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:STE 403
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-674-4730
Practice Address - Fax:847-674-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1780644120OtherBERNARD HANKIN, NPI#
IL1255321873OtherSUNBUM KIM, NPI#
IL1255321873OtherSUNBUM KIM, NPI#
ILAH6097047OtherBERNARD HANKIN, DEA#
IL1255321873OtherSUNBUM KIM, NPI#
ILG88738Medicare UPIN