Provider Demographics
NPI:1013201524
Name:DR JOSEPH S KIM DPM
Entity Type:Organization
Organization Name:DR JOSEPH S KIM DPM
Other - Org Name:DR. JOSEPH KI M - FOOT AND ANKLE SPECIALIST, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-989-1699
Mailing Address - Street 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:STE 515
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-989-1699
Mailing Address - Fax:773-989-1698
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:STE 515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-989-1699
Practice Address - Fax:773-989-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004326213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004326Medicaid
ILT87144Medicare UPIN
IL6244210001Medicare NSC