Healthcare Provider Details

I. General information

NPI: 1053236604
Provider Name (Legal Business Name): KEVIN KLEIN-CARDENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 10/09/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W ARMITAGE AVE
CHICAGO IL
60647
US

IV. Provider business mailing address

204 N GENESEE ST
WAUKEGAN IL
60085-4262
US

V. Phone/Fax

Practice location:
  • Phone: 773-433-1995
  • Fax:
Mailing address:
  • Phone: 847-441-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: