Active NPI
Jung E Kim, M.D.
- Family Medicine Physician
- Woodridge, IL
National Provider Identifier
1700978210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-103739
- Practice address
- 7530 Woodward Ave
Woodridge, IL 60517-3100 - Phone
- (630) 910-1177
- Fax
- (630) 910-6995
- NPI assigned
- Sep 29, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-103739 | IL | Primary |
Addresses
Primary practice location
7530 Woodward Ave
Woodridge, IL 60517-3100
Mailing address
7530 Woodward Ave
Woodridge, IL 60517-3100
Phone (630) 910-1177
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036103739 | Medicaid | IL | |
| 363468127 | Other | IL | TAX ID NO |
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 |
|---|---|---|---|
| 036-103739 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Partners in Health of Sterling | Past | Accepting new patients | |
| Partners in Health of the Rock River Valley SC | 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 and National Provider Directory roles.
-
- Clinic/Center
- Sterling, IL
- NPI 1356526040
-
- Chiropractor
- Sterling, IL
- NPI 1053524157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1700978210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7530 WOODWARD AVE",
"city": "WOODRIDGE",
"state": "IL",
"postal_code": "605173100",
"telephone_number": "630-910-1177",
"fax_number": "630-910-6995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7530 WOODWARD AVE",
"city": "WOODRIDGE",
"state": "IL",
"postal_code": "605173100",
"telephone_number": "630-910-1177",
"fax_number": "630-910-6995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JUNG",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-103739",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036103739",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID NO",
"identifier": "363468127",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.