Provider Demographics
NPI:1790968816
Name:KIM, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 W SUNSET RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2215
Mailing Address - Country:US
Mailing Address - Phone:702-483-4483
Mailing Address - Fax:702-483-4493
Practice Address - Street 1:8530 W SUNSET RD
Practice Address - Street 2:SUITE 230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2215
Practice Address - Country:US
Practice Address - Phone:702-483-4483
Practice Address - Fax:702-483-4493
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87256207R00000X
NV13226207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1790968816Medicaid
NV1790968816OtherNPI
NV1790968816Medicaid