Healthcare Provider Details

I. General information

NPI: 1285325043
Provider Name (Legal Business Name): ANDREW PANSUB KIM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 IRVINE CENTER DR
IRVINE CA
92618-4219
US

IV. Provider business mailing address

8607 IRVINE CENTER DR
IRVINE CA
92618-4219
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-4330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: