MEDICARE: JANGSOO KIM MD

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	207L00000X	Anesthesiology Physician		IL

General Provider Information

NPI Number	:	1497748826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANGSOO KIM MD

Provider Business Mailing Address
First Line	:	PO BOX 265
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-0265
Country	:	US
Telephone Number	:	847-291-7422
Fax Number	:	847-480-1478

Provider Business Practice Location Address
First Line	:	1044 N FRANCISCO AVE
Second Line	:	NORWEGION AMERICAN HOSPITAL
City	:	CHICAGO
State	:	IL
Zip	:	60622-2743
Country	:	US
Telephone Number	:	773-292-8333
Fax Number	:

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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