Individual
JUSTIN KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 GOOD SAMARITAN WAY, MOUNT VERNON, IL 62864-2402
(618) 899-4600
Mailing address
9726 WHISTLING VALLEY RD, LAKE ELMO, MN 55042-4455
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/22/2026
Last updated
04/22/2026
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