David Sungjin Kim, M.D.
Individual provider Active NPI Family Medicine Physician · Chicago, IL
NPI 1821159948 · NPPES record last updated Dec 31, 2019
Key facts
- NPI
- 1821159948
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036114570 (IL)
- Practice address
- 5425 W Lake St
Chicago, IL 60644-2342 - Phone
- (773) 378-3347
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- PCC Community Wellness Center
Practice addresses (Care Compare)
14 Lake St
Oak Park, IL 60302-2606
Phone 7083830113220005
3 Erie CT
Suite 1300
Oak Park, IL 60302-2519
Phone (708) 406-3929
3456 W Franklin Blvd
Chicago, IL 60624-1308
Phone 7735336013238
5425 W Lake St
Chicago, IL 60644-2342
Phone (773) 413-1920
5461 W Lake St
Chicago, IL 60644-2342
Phone 7083830113220005
Hospital & facility affiliations
- Northwest Community Hospital 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110411000813 | IL | Practitioner - Family Practice | 5395828040 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PCC Community Wellness Center | Current |
Accepting new patients | |
| PCC Community Wellness Center | Current |
Accepting new patients | |
| PCC Community Wellness Center | Past | Accepting new patients |
Locations
5425 W Lake St
Chicago, IL 60644
Phone (773) 378-3347
14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113
Interoperability endpoints
- david.kim.1@13158.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036114570 | IL | Yes |
Addresses
Primary practice location
5425 W Lake St
Chicago, IL 60644-2342
Mailing address
24 Concord Dr
Oak Brook, IL 60523-1767
Other practice location 1
24 Concord Dr
Oak Brook, IL 60523-1767
Phone (312) 560-1450
Other providers in Chicago, IL
- Daniel Kim
- Daniel Y Kim
- David Kim
- David Dong Jin Kim
- David H Kim
- DO Young Kim
- Donghwan Kim
- Donghyun Kim
- Doo Hyun Kim
- Dustin Kim
All providers in Chicago, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.