Healthcare Provider Details

I. General information

NPI: 1013201524
Provider Name (Legal Business Name): DR JOSEPH S KIM DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004326
License Number StateIL

VIII. Authorized Official

Name: DR. JOSEPH S KIM
Title or Position: DOCTOR
Credential: DPM
Phone: 773-989-1699