Provider Demographics
NPI:1669825998
Name:ANDRONICA INC
Entity Type:Organization
Organization Name:ANDRONICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-377-6312
Mailing Address - Street 1:2234 HUNTCREST WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8150
Mailing Address - Country:US
Mailing Address - Phone:678-377-6312
Mailing Address - Fax:
Practice Address - Street 1:1160 OLD PEACHTREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5125
Practice Address - Country:US
Practice Address - Phone:678-473-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty