Organization Active NPI

Joon Woo Kim, M.D., SC.

  • Rheumatology Physician
  • Grayslake, IL
National Provider Identifier
1184618209
Registry record updated Feb 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
JOON WOO KIM, M.D., SC.
Practice address
925 Hoffner Drive
Grayslake, IL 60030
Phone
(847) 223-6330
NPI assigned
Sep 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2010

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

Authorized official

Name
Joon Woo Kim, M.D.NPI 1730173030
Title
President
Phone
(847) 223-6330

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RR0500X 036088083 IL
Rheumatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RR0500X Primary

Addresses

Primary practice location

925 Hoffner Drive
Grayslake, IL 60030

Mailing address

925 Hoffner Drive
Grayslake, IL 60030
Phone (847) 223-6330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100206000049 IL Part B Supplier - Clinic/Group Practice 5597808923 Receives reassigned benefits from 1 practitioner
Practice locations: Grayslake, IL

National Provider Directory

National Provider Directory

Locations

925 Hoffner Dr
Grayslake, IL 60030
Phone (847) 223-6330

Practitioners & affiliated clinicians

Practitioners 1

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": "1125619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1184618209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 HOFFNER DRIVE",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "60030",
            "telephone_number": "847-223-6330",
            "fax_number": "847-223-6382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 HOFFNER DRIVE",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "60030",
            "telephone_number": "847-223-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOON WOO KIM, M.D., SC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-02",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JOON",
        "authorized_official_middle_name": "WOO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-223-6330",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IL",
            "license": "036088083",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.