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General NPI Number Information
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NPI Number | 1578517801
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Entity Type | Individual
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Provider Name | ANDREW D KIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 573 MARTIN LUTHER KING JR BLVD
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City | NEWARK
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State | NJ
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Zip | 07102-1215
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Country | US
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Telephone | 973-621-6678
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 ANDERSON AVE SUITE #D
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City | FORT LEE
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State | NJ
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Zip | 07024-1770
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Country | US
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Telephone |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 20618
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License Number State | NJ
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