Active NPI
Sang Yoon Kim
- Pharmacist
- Chicago, IL
National Provider Identifier
1578150660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051287307
- Practice address
- 342 E Illinois St
Chicago, IL 60611-4304 - Phone
- (312) 467-0485
- Fax
- (312) 467-0662
- NPI assigned
- Dec 23, 2020
- Last updated
- Dec 23, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051287307 | IL | Primary |
Addresses
Primary practice location
342 E Illinois St
Chicago, IL 60611-4304
Mailing address
342 E Illinois St
Chicago, IL 60611-4304
Phone (312) 467-0485
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7392 | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | rxm.02340@store.walgreens.com | Direct |
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 |
|---|---|---|---|
| 051287307 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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": "1608681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608681600000",
"number": "1578150660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "342 E ILLINOIS ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606114304",
"telephone_number": "312-467-0485",
"fax_number": "312-467-0662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "342 E ILLINOIS ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606114304",
"telephone_number": "312-467-0485",
"fax_number": "312-467-0662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SANG",
"middle_name": "YOON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-23",
"last_updated": "2020-12-23",
"certification_date": "2020-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051287307",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7392",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "rxm.02340@store.walgreens.com",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "email",
"address_1": "342 E Illinois St",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606114304",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.