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ANDREW KIM D.D.S.
NPI 1922485408
Dentist in Wilmington, CA

Active since May 04, 2015PECOS Enrolled
200 E ANAHEIM ST, WILMINGTON, CA 90744(424) 210-4400(424) 368-6683 Get Directions Write a Review

NPPES record last updated: September 10, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Andrew Kim D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDREW KIM D.D.S. (NPI 1922485408) is an individual dentist in Wilmington, California, licensed in California (100615) and active in the NPI registry since May 2015. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922485408
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameANDREW KIMCredential: D.D.S.
Location Address200 E ANAHEIM STWilmington, CA 90744-4516
Mailing Address2550 W Main St Ste 301Alhambra, CA 91801-7003 · (626) 457-6900 · Fax (626) 457-5022
Phone(424) 210-4400
Fax(424) 368-6683
Sole ProprietorNo
Enumeration DateMay 4, 2015
Last NPPES UpdateSeptember 10, 2019
✔ NPI 1922485408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in CA · 100615
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
200 E ANAHEIM ST, Wilmington, CA 90744
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Andrew Kim D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Andrew Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Northeast Community Clinic
Same address
Federally Qualified Health Center (FQHC)
200 E ANAHEIM ST
Wilmington, CA 90744
  • Reassigned Medicare billing, California enrollment
  • 45 clinicians in this Medicare group
NPI 1700097540 (310) 522-8700

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90744 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EMMA B. TREJO MD
Internal Medicine
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (310) 522-8700
MS. JOSEPHINE MARLENE SERVIN L.C.S.W
Social Worker (Clinical)
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (310) 522-8700
LAURA MOTA DDS
Dentist (Dental Public Health)
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (888) 311-6322
DR. FANTAYE MERID M.D.
Family Medicine
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (310) 522-8700
VERONICA ROCIO GAMARRA
Health Educator
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (310) 522-8700
KAYLA NOELLE MACAPAGAL
Physician Assistant
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (310) 522-8700
MR. DAVID LOREN MARCUS M.D.
Psychiatry & Neurology (Psychiatry)
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (310) 522-8700
LUISA RAMIREZ
Health Educator
200 E ANAHEIM ST
WILMINGTON, CA 90744
Los Angeles County (310) 522-8700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andrew Kim's NPI number?

The NPI number for Andrew Kim is 1922485408. It was assigned to this individual provider in the NPPES registry on May 4, 2015.

Where is Andrew Kim located?

Andrew Kim practices at 200 E Anaheim St, Wilmington, CA 90744. The listed phone number is (424) 210-4400.

What is Andrew Kim's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Andrew Kim enrolled in Medicare?

Yes. Andrew Kim is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Andrew Kim's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Andrew Kim reassigns Medicare benefits to Northeast Community Clinic (Wilmington, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Andrew Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Andrew Kim was last updated on September 10, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.