Provider Demographics
NPI:1992388003
Name:ANDES MEDICAL CARE APC
Entity Type:Organization
Organization Name:ANDES MEDICAL CARE APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-787-2914
Mailing Address - Street 1:2975 TREAT BLVD STE B1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3687
Mailing Address - Country:US
Mailing Address - Phone:925-357-9033
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD STE B1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3687
Practice Address - Country:US
Practice Address - Phone:925-357-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty