NPIMap

Organization Active NPI

King Community Mental Health Center Corp

  • Neurology Physician
  • Chicago, IL
National Provider Identifier
1003056557
Registry record updated Jun 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036089152 Issued in IL
Legal business name
KING COMMUNITY MENTAL HEALTH CENTER CORP
Practice address
4455 S King Drive
Suite 101
Chicago, IL 60653-3310
Phone
(773) 536-2700
Fax
(773) 751-2250
NPI assigned
Feb 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Roueen Rafeyan, MDNPI 1003891458
Title
Owner
Phone
(773) 536-2700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 036089152 IL Primary

Addresses

Primary practice location

4455 S King Drive
Suite 101
Chicago, IL 60653-3310

Mailing address

4455 S King Drive
Suite 101
Chicago, IL 60653-3310
Phone (773) 536-2700

National Provider Directory

National Provider Directory

Locations

6033 N Sheridan Rd
Ste N6
Chicago, IL 60660
Phone (773) 275-4800

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245888000000",
    "number": "1003056557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 S KING DRIVE",
            "address_2": "SUITE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606533310",
            "telephone_number": "773-536-2700",
            "fax_number": "773-751-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 S KING DRIVE",
            "address_2": "SUITE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606533310",
            "telephone_number": "773-536-2700",
            "fax_number": "773-751-2250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING COMMUNITY MENTAL HEALTH CENTER CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-24",
        "last_updated": "2009-06-25",
        "status": "A",
        "authorized_official_last_name": "RAFEYAN",
        "authorized_official_first_name": "ROUEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-536-2700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036089152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.