Provider Demographics
NPI:1528249067
Name:KIM, ANDREW INBAE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:INBAE
Last Name:KIM
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 SE BROOKLYN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1925
Mailing Address - Country:US
Mailing Address - Phone:503-520-8859
Mailing Address - Fax:503-627-0919
Practice Address - Street 1:8283 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2871
Practice Address - Country:US
Practice Address - Phone:503-244-7331
Practice Address - Fax:503-662-6344
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1057175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath