Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 11170 | CA |
N | 2081P2900X | Pain Medicine | 20A11170 | CA |
Y | 2081P2900X | Pain Medicine | DO1610 | NV |
N | 2081P2900X | Pain Medicine | M9411 | TX |
NPI | 1417100918 |
---|---|
Provider Name | Andrew Kim |
First Address | Las Vegas, NV 89121-3609 |
Second Address | Las Vegas, NV 89121-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 26/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1417100918 | (05) | NV |