Provider Demographics
NPI:1912009747
Name:KIM, DANIEL IKJAE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:IKJAE
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 1:5908 HUBBARD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4823
Mailing Address - Country:US
Mailing Address - Phone:301-230-9893
Mailing Address - Fax:301-230-0161
Practice Address - Street 1:5908 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4823
Practice Address - Country:US
Practice Address - Phone:301-230-9893
Practice Address - Fax:301-230-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40078207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203341100Medicaid
MDF50837Medicare UPIN
MD203341100Medicaid