Provider Demographics
NPI:1700070455
Name:KIM, DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44439 17TH ST W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2831
Mailing Address - Country:US
Mailing Address - Phone:661-723-1461
Mailing Address - Fax:661-942-7082
Practice Address - Street 1:44439 17TH ST W
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2831
Practice Address - Country:US
Practice Address - Phone:661-723-1461
Practice Address - Fax:661-942-7082
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics