Provider Demographics
NPI:1578626164
Name:KIM, ANDREW KI-MYUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KI-MYUNG
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 1:595 MADISON AVE RM 1204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1949
Mailing Address - Country:US
Mailing Address - Phone:212-593-0303
Mailing Address - Fax:212-688-3809
Practice Address - Street 1:595 MADISON AVE RM 1204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1949
Practice Address - Country:US
Practice Address - Phone:212-593-0303
Practice Address - Fax:212-688-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY472771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE4481Medicare ID - Type UnspecifiedORAL AND MAXILLOFACIAL