Active NPI
David Dong Jin Kim
- Urology Physician
- Chicago, IL
National Provider Identifier
1649915364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 125.079702
- Practice address
- 5841 S Maryland Ave # Mc5028
Chicago, IL 60637-1443 - Phone
- (773) 702-1860
- NPI assigned
- Apr 28, 2022
- 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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | 125.079702 | IL | Primary |
Addresses
Primary practice location
5841 S Maryland Ave # Mc5028
Chicago, IL 60637-1443
Mailing address
150 Harvester Dr Ste 300
Burr Ridge, IL 60527-5965
Phone (773) 702-1150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220708003240 | IL | Order and Referring Only - Urology | 7012397987 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.079702 | IL | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1649915364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 HARVESTER DR STE 300",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605275965",
"telephone_number": "773-702-1150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5841 S MARYLAND AVE # MC5028",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371443",
"telephone_number": "773-702-1860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DAVID",
"middle_name": "DONG JIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-28",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IL",
"license": "125.079702",
"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 May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.