Provider Demographics
NPI:1639513229
Name:KIM, DANIEL BYEONGHEUI (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BYEONGHEUI
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ROCKEFELLER AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1677
Mailing Address - Country:US
Mailing Address - Phone:877-644-8346
Mailing Address - Fax:
Practice Address - Street 1:1330 ROCKEFELLER AVE STE 520
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1677
Practice Address - Country:US
Practice Address - Phone:425-297-5200
Practice Address - Fax:425-259-8600
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD610682882086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery