Healthcare Provider Details

I. General information

NPI: 1821096785
Provider Name (Legal Business Name): JOSEPH SUN KIM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE STE 515
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE STE 515
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-1699
  • Fax: 773-989-1698
Mailing address:
  • Phone: 773-989-1699
  • Fax: 773-989-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004326
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004326
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: