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NPI Code Detail

MEDICARE: JACOB KIM

MEDICARE: JACOB KIM
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
1183500000XPharmacist051.292294IL

General Provider Information

NPI Number : 1770877722
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB KIM
Provider Business Mailing Address
First Line : 2656 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2019
Country : US
Telephone Number : 773-252-2210
Fax Number : 773-252-2210
Provider Business Practice Location Address
First Line : 2656 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2019
Country : US
Telephone Number : 773-252-2210
Fax Number : 773-252-2210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2011
Last Update Date : 06/07/2011

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Directions to “ JACOB KIM ” Practice Location

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