Active NPI
Min Kwan Kim, M.D.
- Internal Medicine Physician
- Great Lakes, IL
National Provider Identifier
1407818990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01055659A
- Practice address
- 3001 6TH St
Specialty Medicine-Cardiology
Great Lakes, IL 60088-3210 - Phone
- (847) 688-3444
- NPI assigned
- Apr 3, 2006
- 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 | 01055659A | IN | Primary |
Addresses
Primary practice location
3001 6TH St
Specialty Medicine-Cardiology
Great Lakes, IL 60088-3210
Mailing address
1572 Maple Ave
Apt 401
Evanston, IL 60201-4328
Phone (619) 534-1242
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 |
|---|---|---|---|
| 01055659A | IN | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285545600000",
"number": "1407818990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1572 MAPLE AVE",
"address_2": "APT 401",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014328",
"telephone_number": "619-534-1242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 6TH ST",
"address_2": "SPECIALTY MEDICINE-CARDIOLOGY",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600883210",
"telephone_number": "847-688-3444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MIN",
"middle_name": "KWAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2010-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "01055659A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.