Provider Demographics
NPI:1518340793
Name:KIM, ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 US HIGHWAY 130
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4805
Mailing Address - Country:US
Mailing Address - Phone:732-940-1111
Mailing Address - Fax:732-297-5140
Practice Address - Street 1:2208 US HIGHWAY 130
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4805
Practice Address - Country:US
Practice Address - Phone:732-940-1111
Practice Address - Fax:732-297-5140
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026077001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice