Provider Demographics
NPI:1518074681
Name:LI, LINDA KUN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KUN
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KUN
Other - Middle Name:LINDA
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1941 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2466
Mailing Address - Country:US
Mailing Address - Phone:312-808-1200
Mailing Address - Fax:312-808-1400
Practice Address - Street 1:1935 S STATE ST
Practice Address - Street 2:UNIT C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1694
Practice Address - Country:US
Practice Address - Phone:312-808-1200
Practice Address - Fax:312-808-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099744208100000X, 2081P2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366854012OtherUSPS
IL036099744Medicaid
IL10132102OtherBCBS
H19635Medicare UPIN
IL036099744Medicaid