Individual provider · Type 1 NPI

Justin Kim

Student in an Organized Health Care Education/Training Program · Mount Vernon, IL

NPI number 1780529107 Active

Practice location

1 Good Samaritan Way
Mount Vernon, IL 62864-2402

Call (618) 899-4600 Map

Mailing address

9726 Whistling Valley Rd
Lake Elmo, MN 55042-4455

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1780529107

Justin Kim's National Provider Identifier is 1780529107, issued on Apr 22, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Mount Vernon, IL. The record was last updated on Apr 22, 2026.