Andrew D. Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

050969 Issued in NY

Practice address

6741 Myrtle Ave
Glendale, NY 11385-7063

Phone

(718) 821-7750

Fax

(718) 386-1656

NPI assigned

Jun 26, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Evergreen Dentistry, LLC

  • Dental Clinic/Center
  • Bayside, NY
  • NPI 1790981579
  NPD (past) Authorized official
• Grace Dental Studio, LLC

  • Dental Clinic/Center
  • Glendale, NY
  • NPI 1497912372
  NPD (past)

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1972709756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6741 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857063",
            "telephone_number": "718-821-7750",
            "fax_number": "718-386-1656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6741 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857063",
            "telephone_number": "718-821-7750",
            "fax_number": "718-386-1656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANDREW",
        "middle_name": "D.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-26",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "050969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02685578",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elina Kariyeva, DDS
• Katelyn Dobranski OT
• Inayat Kaur, PT
• Yuriy Khasdan, DDS
• Kaitlyn Nicole Kilpatrick
• Emily Kim
• Esther Kim, LMFT
• Harrison Kim
• Shannon Kim
• Maia C King, SLP

• Dentist in Glendale, NY
• Providers in Glendale, NY by specialty
• Dentist in New York

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.