Andrew Young Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

54867 Issued in CA

Practice address

1756 Picasso Ave Ste C
Davis, CA 95618-0549

Phone

(307) 581-3205

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Health and Life Organization, Inc

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1740336734
  Medicare reassignment NPD
• Health and Life Organization, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1427715515

  General Practice

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1043369895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1756 PICASSO AVE STE C",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956180549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1756 PICASSO AVE STE C",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956180549",
            "telephone_number": "307-581-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANDREW",
        "middle_name": "YOUNG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Khan
• Seema Khan, M.D.
• Kimya Khodamardi, DMD
• Yasmin Gabriella Khouri
• Richard Kilfoyle, M.F.T.
• Daniel John Kim, M.D.
• Ian Kim, MD
• Kathleen Kim
• Ryan Sunho Kim, NP-C
• Sophia Kim

• General Practice Dentistry in Davis, CA
• Providers in Davis, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.