Jason Yungsup Kim, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301038461 Issued in MI

Practice address

3420 Illinois St
Uss Tranquillity Clinic 1007
Great Lakes, IL 60088-3161

Phone

(847) 688-6755

Fax

(847) 688-6179

NPI assigned

Sep 13, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280102400000",
    "number": "1346435112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 ILLINOIS STREET",
            "address_2": "USS TRANQUILLITY MEDICAL CLINIC 1007",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600885230",
            "telephone_number": "847-688-6755",
            "fax_number": "847-688-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 ILLINOIS ST",
            "address_2": "USS TRANQUILLITY CLINIC 1007",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600883161",
            "telephone_number": "847-688-6755",
            "fax_number": "847-688-6179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JASON",
        "middle_name": "YUNGSUP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-13",
        "last_updated": "2010-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301038461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liam Richard Kastner
• Karen S Kato, OD
• Sherri Lynn Kenig
• Warren K Kennedy, PA-C
• Dorothy C Kent, MSN,PNP
• Min Kwan Kim, M.D.
• Bonnie J. Kimoto, R.D.
• Michelle Ann Klupp, RDH
• Heather Koder, PTA
• Seth David Koerner, RPH

• Family Medicine Physician in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2010; 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.

Verify at the official NPI Registry.