Provider Demographics
NPI:1992790976
Name:KIM, ANDREW S (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13710 FRANKLIN AVE
Mailing Address - Street 2:SUITE #L-1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3842
Mailing Address - Country:US
Mailing Address - Phone:718-359-0005
Mailing Address - Fax:
Practice Address - Street 1:13710 FRANKLIN AVE
Practice Address - Street 2:SUITE #L-1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3842
Practice Address - Country:US
Practice Address - Phone:718-359-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2010-01-27
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NY170531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY35335AMedicare ID - Type Unspecified
NYD79330Medicare UPIN