Healthcare Provider Details

I. General information

NPI: 1609028539
Provider Name (Legal Business Name): KYU YUP KIM MHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 BURLINGTON AVE
WESTERN SPRINGS IL
60558-1516
US

IV. Provider business mailing address

707 W WAVELAND AVE #1001
CHICAGO IL
60613-4188
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-0826
  • Fax: 708-354-0867
Mailing address:
  • Phone: 773-366-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: