Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Kim Ladell Luster

Individual provider Surgical Technologist · NPI 1396870051

Mr. Kim Ladell Luster is a Surgical Technologist in Waukegan, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2007
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Practice location Address checks out

2400 N Samson Way APT#2D
Waukegan, IL 60087-5079
Phone: (122) 439-9931
Fax: (122) 494-4008
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Technologist (primary) Taxonomy 246ZS0410X (IL)

Record details

NPI number1396870051
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 22, 2007
Last updated in NPPESJuly 8, 2007

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