Organization
DONGWON ACUPUNCTURE CORP
Active
Other names
Richard Kim
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD KIM L.AC (CLINICAL DIRECTOR)
(224) 938-9521
Entity
Organization
Contact information
Practice address
1600 DEMPSTER ST STE 206, PARK RIDGE, IL 60068-1172
(224) 938-9521
Mailing address
1600 DEMPSTER ST STE 206, PARK RIDGE, IL 60068-1172
(224) 410-7898
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
063005247982
MADICAID
IL
Enumeration date
06/24/2021
Last updated
06/29/2021
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