Andrew D Kim, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

20618 Issued in NJ

Practice address

573 Martin Luther King Jr Blvd
Newark, NJ 07102-1215

Phone

(973) 621-6678

NPI assigned

May 20, 2006

Last updated

Sep 23, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bethel Oral Surgery & Implants, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Lee, NJ
  • NPI 1881174969
  NPD Authorized official
• Shelton Oral Surgery & Implant Center, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Irvington, NJ
  • NPI 1649834243
  NPD Authorized official
• Bethel Oral Surgery LLC

  dba Bethel Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Lee, NJ
  • NPI 1780992958
  NPD (past) Authorized official

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285200000000",
    "number": "1578517801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 ANDERSON AVE",
            "address_2": "SUITE #D",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070241770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "573 MARTIN LUTHER KING JR BLVD",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071021215",
            "telephone_number": "973-621-6678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANDREW",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2010-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "20618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8049301",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kidney Life, LLC (Newark Mt Pleasant Dialysis)
• Daniel Richard Kifner III, MD
• Kouji Kikuyama, PHYSICIAN ASSISTANT
• Mary Lori Kiledjian, DMD
• Kelly Kilroy
• Brian Kim, MD
• Christine Soo Hee Kim, MD
• Daejin Michael Kim, DMD
• Danbee Kim, M.D.
• Daniel Kim, DMD

• Oral and Maxillofacial Surgery (Dentist) in Newark, NJ
• Providers in Newark, NJ by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.