Chang Kwon Kim, M.D.,F.A.C.S.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036060318 Issued in IL

Practice address

0N300 Armstrong LN
Geneva, IL 60134-6081

Phone

(630) 208-1700

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360627200000",
    "number": "1104883768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 546",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601740546",
            "telephone_number": "630-208-1700",
            "fax_number": "630-208-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "0N300 ARMSTRONG LN",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601346081",
            "telephone_number": "630-208-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHANG",
        "middle_name": "KWON",
        "credential": "M.D.,F.A.C.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2013-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036060318",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036060318",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036060318",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Viquar M Khan-Mundozie, MD
• Atif Khan
• Faisal Q. Khan, M.D.
• Khanna Dentistry P.C.
• Neeraj Khanna, D.D.S.
• George Kim, M.D.
• Kevin M King, MD
• Lesliann King, ED.D.
• Eric Andrew Kirkman, PTA
• Alexis Kissane, RBT-18-47109

• Surgery Physician in Geneva, IL
• Providers in Geneva, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; 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.