Provider Demographics
NPI:1063526317
Name:DANIEL H KIM D O A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DANIEL H KIM D O A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-838-9710
Mailing Address - Street 1:1905 MCDANIEL STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7170
Mailing Address - Country:US
Mailing Address - Phone:702-838-9710
Mailing Address - Fax:702-838-9705
Practice Address - Street 1:1905 MCDANIEL STREET
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512055Medicaid
NVV101449Medicare PIN