Provider Demographics
NPI:1588321897
Name:KIM, ANDREW HUI-DONG (PHARMD, MS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:HUI-DONG
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 S SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5337
Mailing Address - Country:US
Mailing Address - Phone:213-839-8900
Mailing Address - Fax:
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-295-5585
Practice Address - Fax:323-295-0140
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61927183500000X
CA84475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist