Healthcare Provider Details

I. General information

NPI: 1174493597
Provider Name (Legal Business Name): AMANIE KAHOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 W 95TH ST
OAK LAWN IL
60453-2105
US

IV. Provider business mailing address

8638 S KENNETH AVE
CHICAGO IL
60652-3533
US

V. Phone/Fax

Practice location:
  • Phone: 708-599-5000
  • Fax:
Mailing address:
  • Phone: 954-240-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209033708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: