Provider Demographics
NPI:1679980692
Name:ANDREW KIM, DO PLLC
Entity type:Organization
Organization Name:ANDREW KIM, DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-756-7230
Mailing Address - Street 1:4616 W SAHARA AVE
Mailing Address - Street 2:SUITE 261
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2875 SAINT ROSE PKWY
Practice Address - Street 2:SUITE#120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4838
Practice Address - Country:US
Practice Address - Phone:702-243-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO16102081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty