Provider Demographics
NPI:1285841965
Name:KIM, JOSEPH SEUNGMIN (PT)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SEUNGMIN
Last Name:KIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MEADOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9601
Mailing Address - Country:US
Mailing Address - Phone:847-842-8426
Mailing Address - Fax:
Practice Address - Street 1:5150 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-7900
Practice Address - Country:US
Practice Address - Phone:847-215-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist