Provider Demographics
NPI:1114347192
Name:DANIEL D. KIM, D.D.S., LLC
Entity Type:Organization
Organization Name:DANIEL D. KIM, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONGKYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-313-2277
Mailing Address - Street 1:321 BROAD AVE
Mailing Address - Street 2:#5
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2346
Mailing Address - Country:US
Mailing Address - Phone:201-313-2277
Mailing Address - Fax:201-496-6124
Practice Address - Street 1:321 BROAD AVE
Practice Address - Street 2:#5
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2346
Practice Address - Country:US
Practice Address - Phone:201-313-2277
Practice Address - Fax:201-496-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02255900261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care