Active NPI
Kevin Wilson, DDS
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1427548833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019032065
- Practice address
- 9521 S Western Ave
Chicago, IL 60643-1013 - Phone
- (773) 344-9120
- NPI assigned
- May 11, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30.025427 | OH | |
| General Practice Dentistry | 1223G0001X | 019032065 | IL | Primary |
Addresses
Primary practice location
9521 S Western Ave
Chicago, IL 60643-1013
Mailing address
1931 S Clark St Unit C
Chicago, IL 60616-1984
Phone (202) 486-3697
Other practice location 1
2034 Sturbridge Dr Apt B2
Columbus, OH 43209-4424
Phone (202) 486-3697
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.025427 | OH | MD | Dentist |
| 019032065 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761091200000",
"number": "1427548833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1931 S CLARK ST UNIT C",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606161984",
"telephone_number": "202-486-3697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9521 S WESTERN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606431013",
"telephone_number": "773-344-9120"
}
],
"practiceLocations": [
{
"address_1": "2034 Sturbridge Dr Apt B2",
"address_purpose": "LOCATION",
"city": "Columbus",
"state": "OH",
"postal_code": "432094424",
"country_code": "US",
"telephone_number": "202-486-3697",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-11",
"last_updated": "2025-10-22",
"certification_date": "2025-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.025427",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019032065",
"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 Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.