MEDICARE: STEVE KWANGSUN KIM

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	231H00000X	Audiologist	2932	IL

General Provider Information

NPI Number	:	1073791794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE KWANGSUN KIM

Provider Business Mailing Address
First Line	:	1580 SHERMAN AVE
Second Line	:	201
City	:	EVANSTON
State	:	IL
Zip	:	60201-4465
Country	:	US
Telephone Number	:	847-475-8639
Fax Number	:

Provider Business Practice Location Address
First Line	:	4034 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2825
Country	:	US
Telephone Number	:	773-545-3279
Fax Number	:	773-545-6263

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

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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Directions to “ STEVE KWANGSUN KIM ” Practice Location

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