Provider Demographics
NPI:1669676516
Name:BLUM, DANIEL JIN (BA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JIN
Last Name:BLUM
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 POMERADO RD
Mailing Address - Street 2:P.O. BOX 290
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1717
Mailing Address - Country:US
Mailing Address - Phone:303-229-1888
Mailing Address - Fax:
Practice Address - Street 1:10455 POMERADO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1717
Practice Address - Country:US
Practice Address - Phone:303-229-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health