MEDICARE: THE COMPREHENSIVE KOREAN SELF-HELP COMMUNITY CENTER

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	251S00000X	Community/Behavioral Health Agency	6063001	IL

General Provider Information

NPI Number	:	1427224286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMPREHENSIVE KOREAN SELF-HELP COMMUNITY CENTER

Provider Business Mailing Address
First Line	:	4934 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2813
Country	:	US
Telephone Number	:	773-545-8348
Fax Number	:	773-545-0054

Provider Business Practice Location Address
First Line	:	4934 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2813
Country	:	US
Telephone Number	:	773-545-8348
Fax Number	:	773-545-0054

Authorized Official
Title or Position	:	EXECTIVE DIRECTOR
Name	:	JOONG KYUN SHIN
Credential	:
Telephone Number	:	773-545-8348

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	07/21/2022

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