Provider Demographics
NPI:1528400264
Name:KIM, DANIEL S (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD FORGE LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1897
Mailing Address - Country:US
Mailing Address - Phone:610-388-6789
Mailing Address - Fax:
Practice Address - Street 1:300 OLD FORGE LN
Practice Address - Street 2:SUITE 301
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1897
Practice Address - Country:US
Practice Address - Phone:610-388-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0397011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice