Active NPI
Won Yang Kim, M.D.
- Internal Medicine Physician
- Peru, IL
National Provider Identifier
1366441875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036057302
- Practice address
- 920 West St
Suite 218
Peru, IL 61354-2763 - Phone
- (815) 223-6443
- Fax
- (815) 223-7019
- NPI assigned
- Jul 18, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036057302 | IL | Primary |
Addresses
Primary practice location
920 West St
Suite 218
Peru, IL 61354-2763
Mailing address
920 West St
Ste 218
Peru, IL 61354-2763
Phone (815) 223-6443
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036057302 | Medicaid | IL | |
| 110079916 | Other | IL | RR MEDICARE PTAN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036057302 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491523200000",
"number": "1366441875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 WEST ST",
"address_2": "STE 218",
"city": "PERU",
"state": "IL",
"postal_code": "613542763",
"telephone_number": "815-223-6443",
"fax_number": "815-223-7019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 WEST ST",
"address_2": "SUITE 218",
"city": "PERU",
"state": "IL",
"postal_code": "613542763",
"telephone_number": "815-223-6443",
"fax_number": "815-223-7019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "WON",
"middle_name": "YANG",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-18",
"last_updated": "2017-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036057302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036057302",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PTAN",
"identifier": "110079916",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.