MEDICARE: JISU KIM M.D.

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	208M00000X	Hospitalist Physician	036-099933	IL
2	207R00000X	Internal Medicine Physician	036-099933	IL

General Provider Information

NPI Number	:	1275645871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JISU KIM M.D.

Provider Business Mailing Address
First Line	:	1700 W VAN BUREN ST
Second Line	:	SUITE 500
City	:	CHICAGO
State	:	IL
Zip	:	60612-3218
Country	:	US
Telephone Number	:	312-563-2875
Fax Number	:	312-942-3012

Provider Business Practice Location Address
First Line	:	1700 W VAN BUREN ST
Second Line	:	SUITE 500
City	:	CHICAGO
State	:	IL
Zip	:	60612-3218
Country	:	US
Telephone Number	:	312-563-2875
Fax Number	:	312-942-3012

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/25/2022

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Directions to “ JISU KIM M.D.” Practice Location

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