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NPI Code Detail

MEDICARE: DR. ANDREW ROBERT KIM M.D.

MEDICARE: DR. ANDREW ROBERT KIM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician233008MA
22084P0800XPsychiatry Physician036-129834IL

General Provider Information

NPI Number : 1124210109
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW ROBERT KIM M.D.
Provider Business Mailing Address
First Line : 1315 S ADAMS ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4404
Country : US
Telephone Number : 833-484-6359
Fax Number : 888-648-0177
Provider Business Practice Location Address
First Line : 1315 S ADAMS ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4404
Country : US
Telephone Number : 833-484-6359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 04/14/2026

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