Provider Demographics
NPI:1225571656
Name:KIM, DANIEL YEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:YEIL
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:YEIL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5201 WASHINGTON AVE. SUITE A
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4242
Mailing Address - Country:US
Mailing Address - Phone:512-297-6158
Mailing Address - Fax:
Practice Address - Street 1:5201 WASHINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4242
Practice Address - Country:US
Practice Address - Phone:512-297-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030664122300000X
WI1001602-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962883926OtherOFFICE NPI
WI100160215OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
IL019030664OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL319019971OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL019030664OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL319019971OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL019030664OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION