Provider Demographics
NPI:1245865955
Name:KIM, ANDREW HYEON HO
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:HYEON HO
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NASSAU TERMINAL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4997
Mailing Address - Country:US
Mailing Address - Phone:516-280-1000
Mailing Address - Fax:
Practice Address - Street 1:75 NASSAU TERMINAL RD STE 101
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4997
Practice Address - Country:US
Practice Address - Phone:516-280-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist