Provider Demographics
NPI:1720383086
Name:K & Y HEALTHCARE S.C.
Entity Type:Organization
Organization Name:K & Y HEALTHCARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHAROEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-834-1428
Mailing Address - Street 1:899 SKOKIE BLVD SPC 333
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4023
Mailing Address - Country:US
Mailing Address - Phone:847-834-1428
Mailing Address - Fax:855-265-2722
Practice Address - Street 1:899 SKOKIE BLVD SPC 333
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4023
Practice Address - Country:US
Practice Address - Phone:847-834-1428
Practice Address - Fax:855-265-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0426197052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty