Provider Demographics
NPI:1154585800
Name:DANIEL K. KIM, DDS, INC
Entity type:Organization
Organization Name:DANIEL K. KIM, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISRATOR
Authorized Official - Prefix:
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 1:1959 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4349
Mailing Address - Country:US
Mailing Address - Phone:714-615-2875
Mailing Address - Fax:714-991-7060
Practice Address - Street 1:1959 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4349
Practice Address - Country:US
Practice Address - Phone:714-991-7007
Practice Address - Fax:714-991-7060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL K. KIM, DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-11
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty