Provider Demographics
NPI:1184697625
Name:KIM, ANDREW C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2645 N MAYFAIR RD
Mailing Address - Street 2:#200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1304
Mailing Address - Country:US
Mailing Address - Phone:414-479-1800
Mailing Address - Fax:414-479-1813
Practice Address - Street 1:2645 N MAYFAIR RD
Practice Address - Street 2:#200
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1304
Practice Address - Country:US
Practice Address - Phone:414-479-1800
Practice Address - Fax:414-479-1813
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-01-12
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Provider Licenses
StateLicense IDTaxonomies
WI31338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000201170Medicare PIN
WIF28293Medicare UPIN