Healthcare Provider Details

I. General information

NPI: 1275489171
Provider Name (Legal Business Name): JS SLEEP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18610 BURNHAM AVE STE D
LANSING IL
60438-3500
US

IV. Provider business mailing address

236 S RACINE AVE APT 203
CHICAGO IL
60607-2919
US

V. Phone/Fax

Practice location:
  • Phone: 708-895-0778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JEE SUN KIM
Title or Position: OWNER
Credential: DDS
Phone: 571-263-4824