Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 29894 | TX |
N | 1223P0300X | Periodontist | 58699 | CA |
NPI | 1083911846 |
---|---|
Provider Name | Andrew Kim |
First Address | Dallas, TX 75284-0641 |
Second Address | Katy, TX 77449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2011 |
Last Update Date | 23/12/2020 |