Provider Demographics
NPI:1295766483
Name:KIM, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
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 1:625 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 2550
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3110
Mailing Address - Country:US
Mailing Address - Phone:312-640-7746
Mailing Address - Fax:312-640-7736
Practice Address - Street 1:625 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3110
Practice Address - Country:US
Practice Address - Phone:312-640-7746
Practice Address - Fax:312-640-7736
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1085192084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I10783Medicare UPIN