MEDICARE: DR. JEE HOON KIM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor		IL

General Provider Information

NPI Number	:	1003844895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEE HOON KIM D.C.

Provider Business Mailing Address
First Line	:	2317 W CHICAGO AVE
Second Line	:	2 FL.
City	:	CHICAGO
State	:	IL
Zip	:	60622-4723
Country	:	US
Telephone Number	:	773-252-9740
Fax Number	:	773-252-9746

Provider Business Practice Location Address
First Line	:	2317 W CHICAGO AVE
Second Line	:	2 FL.
City	:	CHICAGO
State	:	IL
Zip	:	60622-4723
Country	:	US
Telephone Number	:	773-252-9740
Fax Number	:	773-252-9746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/09/2007

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