Healthcare Provider Details

I. General information

NPI: 1275094898
Provider Name (Legal Business Name): BENJAMIN KYI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 WAUKEGAN RD
GLENVIEW IL
60025-2120
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-832-6500
  • Fax: 847-832-6040
Mailing address:
  • Phone: 847-570-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036159280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: