Active NPI
In-Sop Kim
- Speech-Language Pathologist
- Dekalb, IL
National Provider Identifier
1255889762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 3100 Sycamore Rd
Dekalb, IL 60115-9621 - Phone
- (815) 753-1481
- NPI assigned
- Sep 13, 2016
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
3100 Sycamore Rd
Dekalb, IL 60115-9621
Mailing address
3100 Sycamore Rd
Dekalb, IL 60115-9621
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161004001701 | IL | Practitioner - Qualified Speech Language Pathologist | 5597053744 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473724800000",
"number": "1255889762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 SYCAMORE RD",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 SYCAMORE RD",
"city": "DEKALB",
"state": "IL",
"postal_code": "601159621",
"telephone_number": "815-753-1481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "IN-SOP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-13",
"last_updated": "2016-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.