Organization
FULLERTON KIMBALL MEDICAL & SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENLIN XIA M.D (PRESIDENT)
(773) 235-8000
Entity
Organization
Contact information
Practice address
3412 W FULLERTON AVE, CHICAGO, IL 60647-2416
(773) 235-8000
Mailing address
3412 W FULLERTON AVE, CHICAGO, IL 60647-2416
(773) 235-8000
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7003181
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261Q00000X
TAXONOMY CODE
IL
Enumeration date
03/01/2007
Last updated
04/09/2014
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