Provider Demographics
NPI:1760181754
Name:KIM, ANDREW HYUN (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8840 CYPRESS WATERS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4630
Mailing Address - Country:US
Mailing Address - Phone:858-465-2321
Mailing Address - Fax:888-383-2704
Practice Address - Street 1:8840 CYPRESS WATERS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4630
Practice Address - Country:US
Practice Address - Phone:858-465-2321
Practice Address - Fax:888-383-2704
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1374658208100000X, 225100000X
TX3129156208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation