Andrew Kim, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

100615 Issued in CA

Practice address

200 E Anaheim St
Wilmington, CA 90744-4516

Phone

(424) 210-4400

Fax

(424) 368-6683

NPI assigned

May 4, 2015

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.

• Northeast Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Wilmington, CA
  • NPI 1700097540

  Dentist

  Medicare reassignment NPD
• Northeast Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Harbor City, CA
  • NPI 1043725583
  NPD
• Northeast Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, CA
  • NPI 1275226334
  NPD

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1922485408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 W MAIN ST STE 301",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918017003",
            "telephone_number": "626-457-6900",
            "fax_number": "626-457-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E ANAHEIM ST",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907444516",
            "telephone_number": "424-210-4400",
            "fax_number": "424-368-6683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANDREW",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-04",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "100615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Jung, DC
• Negin Kahen, PA-C
• Payam John Kahen, M.D.
• Selene Ketchum, CLEC CBD
• Tariq Tahir Khraishi, O.D.
• Kimbo Drug & Alcohol Rehabilitation Services
• Kimbo Medical Distributor
• Marilyn Kleist, LMFT
• Krynen Chiropractic Inc
• Paul J Krynen, D.C.

• Dentist in Wilmington, CA
• Providers in Wilmington, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.