CHARLES C KIM Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

CANCELLED

Business

First Name

CHARLES

Middle

Last Name

KIM

Business Name

CHARLES C KIM

Original Issue Date

12/16/2003

Effective Date

12/16/2003

Expiration Date

07/31/2005

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/09/2006