Provider Demographics
NPI:1457682445
Name:KIM, ANDREW YOUNGHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:YOUNGHO
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 1:5709 WALNUT WOOD LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2710
Mailing Address - Country:US
Mailing Address - Phone:571-344-4631
Mailing Address - Fax:
Practice Address - Street 1:307 MAPLE AVE W
Practice Address - Street 2:SUIT M
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4307
Practice Address - Country:US
Practice Address - Phone:703-281-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist