Active NPI
Moon Kim, M.D.
- Neonatal-Perinatal Medicine Physician
- Oak Brook, IL
National Provider Identifier
1114963881
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- 036-056827
- Practice address
- 900 Jorie Blvd
Suite 186
Oak Brook, IL 60523-2213 - Phone
- (630) 954-6700
- Fax
- (630) 954-1555
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 036-056827 | IL | Primary |
Addresses
Primary practice location
900 Jorie Blvd
Suite 186
Oak Brook, IL 60523-2213
Mailing address
900 Jorie Blvd
Suite 186
Oak Brook, IL 60523-2213
Phone (630) 954-6700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L76293 | Other | IL | MEDICARE PIN FOR GROUP #645650 |
| 036-085093 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-056827 | IL | MD | Neonatal-Perinatal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1114963881",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 JORIE BLVD",
"address_2": "SUITE 186",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605232213",
"telephone_number": "630-954-6700",
"fax_number": "630-954-1555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 JORIE BLVD",
"address_2": "SUITE 186",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605232213",
"telephone_number": "630-954-6700",
"fax_number": "630-954-1555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MOON",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-21",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "IL",
"license": "036-056827",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PIN FOR GROUP #645650",
"identifier": "L76293",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-085093",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Brook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.