Provider Demographics
NPI:1124182357
Name:KIM, ANDREW M (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:6309 HAZELWEST CT
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1739
Mailing Address - Country:US
Mailing Address - Phone:314-731-1688
Mailing Address - Fax:314-731-7938
Practice Address - Street 1:6309 HAZELWEST CT
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1739
Practice Address - Country:US
Practice Address - Phone:314-731-1688
Practice Address - Fax:314-731-7938
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO142741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry