Provider Demographics
NPI:1073582805
Name:DANIEL Y. KIM, M.D., P.A.
Entity Type:Organization
Organization Name:DANIEL Y. KIM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-461-3970
Mailing Address - Street 1:540 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2322
Mailing Address - Country:US
Mailing Address - Phone:201-461-3970
Mailing Address - Fax:201-242-9061
Practice Address - Street 1:540 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-2322
Practice Address - Country:US
Practice Address - Phone:201-461-3970
Practice Address - Fax:201-242-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65006207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1106389OtherFIRST HEALTH
NJ160591OtherNEW ENGLAND ONE HEALTH
NJ2033258OtherAETNA
CT976044OtherCIGNA
NJ180036662OtherRAILROAD MEDICARE
NJ1537021OtherUNITED HEALTHCARE
NJP672617OtherOXFORD
NJ976044OtherEMPIREBCBS
NJOK4450OtherHEALTHNET
NJ1106389OtherFIRST HEALTH
NJ=========OtherGHI
NJOK4450OtherHEALTHNET
CT976044OtherCIGNA
NJP672617OtherOXFORD
CT976044OtherCIGNA
NJKI896694Medicare ID - Type UnspecifiedMEDICARE NJ
NJ5556420001Medicare NSC