1. Home
  2. Directory
  3. Georgia
  4. Thomasville
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

ETHAN KIM MD
NPI 1417742404
Student in an Organized Health Care Education/Training Program in Thomasville, GA

Active since April 11, 2025
915 GORDON AVE, THOMASVILLE, GA 31792(229) 551-2576(229) 584-7154 Get Directions Write a Review

NPPES record last updated: April 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ethan Kim Md NPPES

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

ETHAN KIM MD (NPI 1417742404) is an individual student in an organized health care education/training program in Thomasville, Georgia and active in the NPI registry since April 2025.

NPPES Registry Identity

NPI1417742404
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameETHAN KIMCredential: MD
Location Address915 GORDON AVEThomasville, GA 31792-6699
Mailing Address1626 Page StPhiladelphia, PA 19121-2320 · (267) 247-2896
Phone(229) 551-2576
Fax(229) 584-7154
Sole ProprietorNo
Enumeration DateApril 11, 2025
NPPES CertifiedApril 11, 2025
✔ NPI 1417742404 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.
915 GORDON AVE, Thomasville, GA 31792
Open in Google Maps ↗

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.

MADISON GRACE MAXWELL NP
Nurse Practitioner (Family)
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (229) 228-2435
DR. PRASHANT BALIGA M.D.
Internal Medicine
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (229) 228-8575
DR. CAMILLE DOMINGO MD
Student in an Organized Health Care Education/Training Program
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (229) 228-2000
MELINDA GREENE
Occupational Therapist
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (229) 228-2823
GEREN THOMAS PHARMD
Pharmacist
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (229) 228-2948
DANIEL JOSE TORRES
Student in an Organized Health Care Education/Training Program
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (229) 228-2000
GARY DAVIDUK CRNA
Nurse Anesthetist, Certified Registered
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (229) 228-2000
JACKSON SETH TUCKER AA
Anesthesiologist Assistant
915 GORDON AVE
THOMASVILLE, GA 31792
Thomas County (800) 232-5703

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 Ethan Kim's NPI number?

The NPI number for Ethan Kim is 1417742404. It was assigned to this individual provider in the NPPES registry on April 11, 2025.

Where is Ethan Kim located?

Ethan Kim practices at 915 Gordon Ave, Thomasville, GA 31792. The listed phone number is (229) 551-2576.

What is Ethan Kim's specialty?

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

When was this NPI record last updated?

The NPPES record for Ethan Kim was last updated on April 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.