Healthcare Provider Details

I. General information

NPI: 1679240048
Provider Name (Legal Business Name): JUNSIK KIM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 S OAK PARK AVE
OAK PARK IL
60304-1218
US

IV. Provider business mailing address

836 S OAK PARK AVE
OAK PARK IL
60304-1218
US

V. Phone/Fax

Practice location:
  • Phone: 708-613-5471
  • Fax:
Mailing address:
  • Phone: 708-613-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36140
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.024441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: