Provider Demographics
NPI:1083731426
Name:KIM, ANDREW S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIL
Other - Middle Name:S
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4913 E FIRESTONE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7395
Mailing Address - Country:US
Mailing Address - Phone:480-656-8935
Mailing Address - Fax:480-656-8935
Practice Address - Street 1:4913 E FIRESTONE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7395
Practice Address - Country:US
Practice Address - Phone:480-656-8935
Practice Address - Fax:480-656-8935
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35320207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44586Medicare UPIN