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NPI Code Detail

MEDICARE: DR. JUN DONG KIM DO

MEDICARE: DR. JUN DONG KIM DO
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
1207V00000XObstetrics & Gynecology Physician036136056IL
2207V00000XObstetrics & Gynecology Physician02004986AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336411610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUN DONG KIM DO
Provider Business Mailing Address
First Line : 338 LARRY POWER RD
Second Line :
City : BOURBONNAIS
State : IL
Zip : 60914-4430
Country : US
Telephone Number : 815-935-4651
Fax Number : 815-935-2970
Provider Business Practice Location Address
First Line : 100 W CHICAGO AVE STE F
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-3261
Country : US
Telephone Number : 219-392-7016
Fax Number : 219-397-6904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2012
Last Update Date : 07/31/2019

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