Active NPI
Jisoo Kim
- Family Medicine Physician
- Berwyn, IL
National Provider Identifier
1144924259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 125.081833
- Practice address
- 3249 Oak Park Ave
Berwyn, IL 60402-3429 - Phone
- (877) 834-7264
- NPI assigned
- Mar 30, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125.081833 | IL | Primary |
Addresses
Primary practice location
3249 Oak Park Ave
Berwyn, IL 60402-3429
Mailing address
3249 Oak Park Ave
Berwyn, IL 60402-3429
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231218002825 | IL | Order and Referring Only - Family Practice | 0840649711 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.081833 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685664000000",
"number": "1144924259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3249 OAK PARK AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3249 OAK PARK AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023429",
"telephone_number": "877-834-7264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JISOO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-30",
"last_updated": "2023-06-02",
"certification_date": "2023-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125.081833",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.