Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS031096 | PA |
NPI | 1154472272 |
---|---|
Provider Name | Dr. Andrew Myoung Kim |
First Address | Lansdale, PA 19446-6073 |
Second Address | Lansdale, PA 19446-1052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 12/04/2020 |