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MS. ELISSA MINJU KIM DDS
NPI 1124721261
Student in an Organized Health Care Education/Training Program in Chicago, IL

Active since March 27, 2023PECOS Enrolled
820 SOUTH WOOD STREET, SUITE 100, MC 675, CHICAGO, IL 60612(312) 996-2933 Get Directions Write a Review

NPPES record last updated: June 11, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 11, 2025, Mar 25, 2025, Mar 27, 2023 (3 updates tracked since 2023).

About Ms. Elissa Minju Kim Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. ELISSA MINJU KIM DDS (NPI 1124721261) is an individual student in an organized health care education/training program in Chicago, Illinois and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124721261
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameMS. ELISSA MINJU KIMCredential: DDS
Location Address820 SOUTH WOOD STREET, SUITE 100, MC 675Chicago, IL 60612
Mailing Address820 South Wood Street, Suite 100, Mc 675Chicago, IL 60612 · (312) 996-2933
Phone(312) 996-2933
Sole ProprietorNo
Enumeration DateMarch 27, 2023
Last NPPES UpdateJune 11, 20253 updates tracked since enumeration
NPPES CertifiedJune 11, 2025
✔ NPI 1124721261 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
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.
820 SOUTH WOOD STREET, Chicago, IL 60612
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Elissa Minju Kim Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EITAN KATZ
Ophthalmology
820 SOUTH WOOD STREET, SUITE 100, MC 675
CHICAGO, IL 60612
Cook County (312) 996-2933
DR. LUNA SAMER NASRY DO
Pediatrics
820 SOUTH WOOD STREET, SUITE 100, MC 675
CHICAGO, IL 60612
Cook County (312) 996-2933
MR. TEVYN COLE SHADLYN M.D.
Student in an Organized Health Care Education/Training Program
820 SOUTH WOOD STREET, SUITE 100, MC 675
CHICAGO, IL 60612
Cook County (312) 996-2933
JUAN RAMON TORRES ANGUIANO MD
Urology
820 SOUTH WOOD STREET, CSN-515
CHICAGO, IL 60612
Cook County (312) 996-9330
JOSHUA ROBERT HABERMANN DDS
Dentist (Oral and Maxillofacial Surgery)
820 SOUTH WOOD STREET, SUITE 100, MC 675
CHICAGO, IL 60612
Cook County (312) 996-2933
DR. WAN KWOK MD
Psychiatry & Neurology (Psychiatry)
820 SOUTH WOOD STREET, SUITE 100, MC 675
CHICAGO, IL 60612
Cook County (312) 996-2933
AMY BIBIANA DE LA TORRE MD
Student in an Organized Health Care Education/Training Program
820 SOUTH WOOD STREET, SUITE 100, MC 675
CHICAGO, IL 60612
Cook County (312) 996-2933
RYAN ALEXANDER GALLO MD, PHD
Student in an Organized Health Care Education/Training Program
820 SOUTH WOOD STREET, SUITE 100, MC 675
CHICAGO, IL 60612
Cook County (312) 996-2933

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Elissa Kim's NPI number?

The NPI number for Elissa Kim is 1124721261. It was assigned to this individual provider in the NPPES registry on March 27, 2023.

Where is Elissa Kim located?

Elissa Kim practices at 820 South Wood Street Suite 100, Mc 675, Chicago, IL 60612. The listed phone number is (312) 996-2933.

What is Elissa Kim's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Elissa Kim enrolled in Medicare?

Yes. Elissa Kim is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Elissa Kim was last updated on June 11, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.