# FULLERTON KIMBALL MEDICAL & SURGICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205964103
- **Authorized official:** DR. RENLIN XIA M.D (PRESIDENT)
- **Authorized official phone:** (773) 235-8000

## Contact information

- **Practice address:** 3412 W FULLERTON AVE, CHICAGO, IL 60647-2416
- **Practice address phone:** (773) 235-8000
- **Mailing address:** 3412 W FULLERTON AVE, CHICAGO, IL 60647-2416
- **Mailing address phone:** (773) 235-8000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 7003181 | IL | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 04/09/2014