Provider Demographics
NPI:1194847939
Name:KIM, ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
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 1:4300 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3563
Mailing Address - Country:US
Mailing Address - Phone:562-799-8300
Mailing Address - Fax:562-799-8302
Practice Address - Street 1:2311 SEAL BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5623
Practice Address - Country:US
Practice Address - Phone:562-799-8300
Practice Address - Fax:562-799-8302
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist