Active NPI
Jane Kim, RN
- Registered Nurse
- Berwyn, IL
National Provider Identifier
1306654009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041561719
- Practice address
- 3249 Oak Park Ave
Berwyn, IL 60402-0715 - Phone
- (708) 783-9100
- NPI assigned
- Dec 26, 2024
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041561719 | IL | Primary |
Addresses
Primary practice location
3249 Oak Park Ave
Berwyn, IL 60402-0715
Mailing address
1758 Wayside Dr SE
Grand Rapids, MI 49546-6241
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041561719 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735171200000",
"number": "1306654009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1758 WAYSIDE DR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495466241"
},
{
"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": "604020715",
"telephone_number": "708-783-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JANE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-26",
"last_updated": "2024-12-26",
"certification_date": "2024-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041561719",
"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 Dec 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.