Provider Demographics
NPI:1629167937
Name:KIM, DANIEL TAECHONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TAECHONG
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 ELA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2317
Mailing Address - Country:US
Mailing Address - Phone:847-726-8999
Mailing Address - Fax:847-726-7999
Practice Address - Street 1:519 ELA RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2317
Practice Address - Country:US
Practice Address - Phone:847-726-8999
Practice Address - Fax:847-726-7999
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice