=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578738662
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUJI HEALTH CONCEPTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2008
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7906 S CRANDON AVE SUITE 1
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60617-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-768-5707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7906 S CRANDON AVE SUITE 1
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60617-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-768-5707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROJECT MANAGER
-----------------------------------------------------
Name | MS. KEISHA ROLLS
-----------------------------------------------------
Credential | CPC
-----------------------------------------------------
Telephone | 630-384-1254
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 36117052
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------