MEDICARE: JONGHYUN 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
1	111NR0400X	Rehabilitation Chiropractor	038012597	IL

General Provider Information

NPI Number	:	1942626627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONGHYUN KIM

Provider Business Mailing Address
First Line	:	1245 MILWAUKEE AVE STE 303
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-2400
Country	:	US
Telephone Number	:	224-704-9164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 MILWAUKEE AVE STE 303
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025
Country	:	US
Telephone Number	:	224-704-9164
Fax Number	:

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

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	07/16/2018

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