MEDICARE: JI SOO KIL MD

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	2084P0800X	Psychiatry Physician	MDR-8495	HI
2	208000000X	Pediatrics Physician	0116035346	VA
3	2084P0804X	Child & Adolescent Psychiatry Physician	036-175647	IL

General Provider Information

NPI Number	:	1013583699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI SOO KIL MD

Provider Business Mailing Address
First Line	:	180 HARVESTER DR STE 110
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6686
Country	:	US
Telephone Number	:	773-702-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # MC1052
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	773-702-0529
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	02/10/2026

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Directions to “ JI SOO KIL MD” Practice Location

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