Chang K Kim MD PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036060318 Issued in IL

Legal business name

CHANG K KIM MD PC

Practice address

0N300 Armstrong LN
Geneva, IL 60134-6081

Phone

(630) 208-1700

NPI assigned

Jun 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chang K Kim

Title

Owner

Phone

(630) 208-1700

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360627200000",
    "number": "1831391689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 546",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601740546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "0N300 ARMSTRONG LN",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601346081",
            "telephone_number": "630-208-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANG K KIM MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2013-02-12",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CHANG",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-208-1700"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "036060318",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036060318",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036060318",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "020019386",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02201303",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Analida Cejagonzalez, ATC
• Central Dupage Physician Group (Northwestern Medicine Regional Medical Group)
• Matthew Edward Cermak, MSW LSW CADC MISA-1
• Josadec Cerrato, PHARMD
• Robert Cesario, PT
• Phyllis C Chang, MD
• Makyla Charles
• Chat With Me Speech Therapy, LLC
• Ameel Hasan Chaudhary, MD
• Charles W Cherry, P.T

• Surgery Physician in Geneva, IL
• Providers in Geneva, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.