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General NPI Number Information
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NPI Number | 1831391689
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Entity Type | Organization
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Legal Business Name | CHANG K KIM MD PC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 0N300 ARMSTRONG LN
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City | GENEVA
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State | IL
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Zip | 60134-6081
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Country | US
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Telephone | 630-208-1700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 546
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City | ST CHARLES
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State | IL
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Zip | 60174-0546
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANG K KIM
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Credential |
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Telephone | 630-208-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036060318
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036060318
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License Number State | IL
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