MEDICARE: KEVIN KOK RD

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	133V00000X	Registered Dietitian	164007850	IL

General Provider Information

NPI Number	:	1285340992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KOK RD

Provider Business Mailing Address
First Line	:	4932 N HARDING AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-7535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4932 N HARDING AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-7535
Country	:	US
Telephone Number	:	630-656-3954
Fax Number	:

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

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/26/2023

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