Provider Demographics
NPI:1437507274
Name:KIM, DANIEL (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9568 KINGS CHARTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7955
Mailing Address - Country:US
Mailing Address - Phone:804-266-8717
Mailing Address - Fax:804-266-5677
Practice Address - Street 1:8081 INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:714-720-6065
Practice Address - Fax:571-472-0540
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267575207R00000X
VA01012715482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine