Provider Demographics
NPI:1407619307
Name:KIM, DANIEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:7045 E COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4413
Mailing Address - Country:US
Mailing Address - Phone:714-822-9677
Mailing Address - Fax:
Practice Address - Street 1:7045 E COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4413
Practice Address - Country:US
Practice Address - Phone:714-822-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist