Active NPI
Kiljung Kenneth Kim, M.D.
- Anesthesiology Physician
- Chicago, IL
National Provider Identifier
1801995113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 036047946
- Practice address
- 8012 S Crandon Ave
Chicago, IL 60617-1124 - Phone
- (773) 356-5381
- Fax
- (773) 356-5186
- NPI assigned
- Sep 22, 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 036047946 | IL | Primary |
Addresses
Primary practice location
8012 S Crandon Ave
Chicago, IL 60617-1124
Mailing address
PO Box 597903
Chicago, IL 60659-7903
Phone (815) 941-1317
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036047946 | Medicaid | IL | |
| 1626751 | Other | IL | BLUE CROSS BLUE SHIELD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414454400000",
"number": "1801995113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 597903",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606597903",
"telephone_number": "815-941-1317",
"fax_number": "815-941-1421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8012 S CRANDON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606171124",
"telephone_number": "773-356-5381",
"fax_number": "773-356-5186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KILJUNG",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2014-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IL",
"license": "036047946",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036047946",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1626751",
"state": "IL"
}
],
"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 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.