Active NPI
S Theresa Kim, M.D.
- General Practice Physician
- Chicago, IL
National Provider Identifier
1366681421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 01059631A
- Practice address
- 5875 N Lincoln Ave
Suite 131
Chicago, IL 60659-4672 - Phone
- (773) 878-7222
- Fax
- (773) 878-7221
- NPI assigned
- Feb 12, 2009
- Last updated
- Mar 3, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 01059631A | IN | Primary |
Addresses
Primary practice location
5875 N Lincoln Ave
Suite 131
Chicago, IL 60659-4672
Mailing address
706 W Huntington Commons Rd
#1A
Mount Prospect, IL 60056-5159
Phone (847) 387-0911
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 |
|---|---|---|---|
| 01059631A | IN | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Toh Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236038400000",
"number": "1366681421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 W HUNTINGTON COMMONS RD",
"address_2": "#1A",
"city": "MOUNT PROSPECT",
"state": "IL",
"postal_code": "600565159",
"telephone_number": "847-387-0911",
"fax_number": "773-878-7221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5875 N LINCOLN AVE",
"address_2": "SUITE 131",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606594672",
"telephone_number": "773-878-7222",
"fax_number": "773-878-7221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "S",
"middle_name": "THERESA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-12",
"last_updated": "2009-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IN",
"license": "01059631A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.