MEDICARE: DR. WON YANG 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	207R00000X	Internal Medicine Physician	036057302	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110079916	OTHER	IL	RR MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1366441875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WON YANG KIM M.D.

Provider Business Mailing Address
First Line	:	920 WEST ST
Second Line	:	STE 218
City	:	PERU
State	:	IL
Zip	:	61354-2763
Country	:	US
Telephone Number	:	815-223-6443
Fax Number	:	815-223-7019

Provider Business Practice Location Address
First Line	:	920 WEST ST
Second Line	:	SUITE 218
City	:	PERU
State	:	IL
Zip	:	61354-2763
Country	:	US
Telephone Number	:	815-223-6443
Fax Number	:	815-223-7019

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/07/2017

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Directions to “ DR. WON YANG KIM M.D.” Practice Location

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