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General NPI Number Information
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NPI Number | 1427224286
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Entity Type | Organization
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Legal Business Name | THE COMPREHENSIVE KOREAN SELF-HELP COMMUNITY CENTER
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4934 N PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60630-2813
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Country | US
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Telephone | 773-545-8348
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Fax | 773-545-0054
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Provider Business Mailing Address
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Address Line | 4934 N PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60630-2813
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Country | US
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Telephone | 773-545-8348
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Fax | 773-545-0054
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Authorized Official
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Title or Position | EXECTIVE DIRECTOR
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Name | JOONG KYUN SHIN
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Credential |
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Telephone | 773-545-8348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6063001
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License Number State | IL
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