MEDICARE: STEPHEN KIM CPO

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	224P00000X	Prosthetist	211.000412	IL
2	222Z00000X	Orthotist	213.000297	IL

General Provider Information

NPI Number	:	1285175109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN KIM CPO

Provider Business Mailing Address
First Line	:	1304 E 47TH ST STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4695
Country	:	US
Telephone Number	:	312-757-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 E 47TH ST STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4695
Country	:	US
Telephone Number	:	312-757-5270
Fax Number	:

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

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	10/16/2024

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Directions to “ STEPHEN KIM CPO” Practice Location

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