Provider Demographics
NPI:1801881297
Name:KIM, DANIEL H (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:H
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1905 MCDANIEL ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7169
Mailing Address - Country:US
Mailing Address - Phone:702-838-9710
Mailing Address - Fax:702-838-9705
Practice Address - Street 1:1905 MC DANIEL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7170
Practice Address - Country:US
Practice Address - Phone:702-838-9710
Practice Address - Fax:702-838-9705
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO736207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1063526317OtherNPI GROUP NUMBER
NV1801881297Medicaid
NV1801881297Medicaid
F89258Medicare UPIN