Basic Information
| Provider Information | |||||||||
| NPI: | 1184070013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3150 SOUTHWYCKE TER | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945361960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109968087 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 ADDISON ST STE 329 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106660854 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | DC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | A173279 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.