Provider Demographics
NPI:1518088608
Name:KIM, DANIEL H (DC, LAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:HO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3116 KINGRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1027
Mailing Address - Country:US
Mailing Address - Phone:818-952-5505
Mailing Address - Fax:
Practice Address - Street 1:3544 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3500
Practice Address - Country:US
Practice Address - Phone:818-952-5505
Practice Address - Fax:323-733-0050
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19499111N00000X
CALAC11044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist