Provider Demographics
NPI:1487124988
Name:SMILE PAIN & REHAB INC
Entity type:Organization
Organization Name:SMILE PAIN & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEONGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:929-233-4979
Mailing Address - Street 1:4800 ESSEX WAY APT 107
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3339
Mailing Address - Country:US
Mailing Address - Phone:929-233-4979
Mailing Address - Fax:
Practice Address - Street 1:1052 S ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4240
Practice Address - Country:US
Practice Address - Phone:847-439-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy