Provider Demographics
NPI:1073843660
Name:KIM, ANDREW CHUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17220 NEWHOPE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4272
Mailing Address - Country:US
Mailing Address - Phone:714-549-0911
Mailing Address - Fax:714-549-9115
Practice Address - Street 1:17220 NEWHOPE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4272
Practice Address - Country:US
Practice Address - Phone:714-549-0911
Practice Address - Fax:714-549-9115
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice