MEDICARE: DR. ANGELO SO TAA KUM MD, MSC

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	207RG0100X	Gastroenterology Physician	125087173	IL

General Provider Information

NPI Number	:	1790620037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELO SO TAA KUM MD, MSC

Provider Business Mailing Address
First Line	:	AVENIDA PRESIDENTE WILSON 1553
Second Line	:	APARTMENT 31
City	:	SAO VICENTE
State	:	SAO PAULO
Zip	:	11320001
Country	:	BR
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	773-702-2278
Fax Number	:

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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