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General NPI Number Information
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NPI Number | 1801995113
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Entity Type | Individual
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Provider Name | KILJUNG KENNETH KIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 8012 S CRANDON AVE
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City | CHICAGO
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State | IL
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Zip | 60617-1124
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Country | US
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Telephone | 773-356-5381
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Fax | 773-356-5186
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Provider Business Mailing Address
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Address Line | PO BOX 597903
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City | CHICAGO
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State | IL
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Zip | 60659-7903
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Country | US
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Telephone | 815-941-1317
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Fax | 815-941-1421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036047946
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License Number State | IL
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