Provider Demographics
NPI:1952092876
Name:KIM, DANIEL SEUNG
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SEUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 SAN HERON CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2914
Mailing Address - Country:US
Mailing Address - Phone:213-434-5009
Mailing Address - Fax:
Practice Address - Street 1:8022 SAN HERON CIR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2914
Practice Address - Country:US
Practice Address - Phone:213-434-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program