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General NPI Number Information
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NPI Number | 1457736928
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Entity Type | Organization
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Legal Business Name | CHICAGO MEDICAL CENTER LIMITED
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 3650 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3611
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Country | US
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Telephone | 773-772-5111
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Fax | 773-772-5114
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Provider Business Mailing Address
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Address Line | 3650 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3611
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Country | US
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Telephone | 773-772-5111
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Fax | 773-772-5114
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YONGSOO KWON
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Credential | M.D.
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Telephone | 773-772-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036120995
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036070641
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License Number State | IL
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