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General NPI Number Information
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NPI Number | 1063396182
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Entity Type | Individual
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Provider Name | ANDREA KIM DMD
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Gender | Female
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2229 SANTA CLARA AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-4472
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Country | US
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Telephone | 510-521-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 SUNSET LN
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City | FULLERTON
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State | CA
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Zip | 92833-1733
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Country | US
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Telephone | 714-743-6039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 111823
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License Number State | CA
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