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General NPI Number Information
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NPI Number | 1184697625
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Entity Type | Individual
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Provider Name | ANDREW C KIM MD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 2645 N MAYFAIR RD #200
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City | WAUWATOSA
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State | WI
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Zip | 53226-1304
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Country | US
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Telephone | 414-479-1800
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Fax | 414-479-1813
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Provider Business Mailing Address
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Address Line | 2645 N MAYFAIR RD #200
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City | WAUWATOSA
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State | WI
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Zip | 53226-1304
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Country | US
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Telephone | 414-479-1800
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Fax | 414-479-1813
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31338
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License Number State | WI
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