Provider Demographics
NPI:1225113889
Name:KIM, DANIEL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3620
Mailing Address - Country:US
Mailing Address - Phone:951-637-0808
Mailing Address - Fax:951-637-1986
Practice Address - Street 1:3993 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3620
Practice Address - Country:US
Practice Address - Phone:951-637-0808
Practice Address - Fax:951-637-1986
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB351321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice