Provider Demographics
NPI:1336360338
Name:DANIEL K. KIM, DDS, INC
Entity Type:Organization
Organization Name:DANIEL K. KIM, DDS, INC
Other - Org Name:VAN BUREN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-615-2875
Mailing Address - Street 1:3993 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3620
Mailing Address - Country:US
Mailing Address - Phone:714-615-2875
Mailing Address - Fax:951-637-1986
Practice Address - Street 1:3993 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3620
Practice Address - Country:US
Practice Address - Phone:951-637-0808
Practice Address - Fax:951-637-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty