MEDICARE: MR. STEPHEN KIM PHARMD, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051296098	IL
2	171100000X	Acupuncturist	198000472	IL

General Provider Information

NPI Number	:	1003073354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN KIM PHARMD, LAC

Provider Business Mailing Address
First Line	:	5643 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5643 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4921
Country	:	US
Telephone Number	:	773-991-9552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	01/15/2021

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