NPIMap

Organization Active NPI

Logan Square Urgent Care Center Corporation

  • Surgery Physician
  • Chicago, IL
National Provider Identifier
1366840415
Registry record updated Dec 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036070641 Issued in IL
Legal business name
LOGAN SQUARE URGENT CARE CENTER CORPORATION
Practice address
2004 N Pulaski Rd
Chicago, IL 60639-3767
Phone
(773) 772-8876
Fax
(773) 252-3091
NPI assigned
Dec 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2014

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

Authorized official

Name
Yongsoo Kwon, M.D.
Title
Physician
Phone
(773) 772-8876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 036070641 IL Primary

Addresses

Primary practice location

2004 N Pulaski Rd
Chicago, IL 60639-3767

Mailing address

2004 N Pulaski Rd
Chicago, IL 60639-3767
Phone (773) 772-8876

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1417737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1366840415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606393767",
            "telephone_number": "773-772-8876",
            "fax_number": "773-252-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606393767",
            "telephone_number": "773-772-8876",
            "fax_number": "773-252-3091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN SQUARE URGENT CARE CENTER CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-05",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "KWON",
        "authorized_official_first_name": "YONGSOO",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "773-772-8876",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "036070641",
            "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 Dec 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.