Provider Demographics
NPI:1194775619
Name:FRUM, DANIEL KIM (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KIM
Last Name:FRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-830-1701
Mailing Address - Fax:
Practice Address - Street 1:2011 NW MYHRE PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8561
Practice Address - Country:US
Practice Address - Phone:360-830-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022155207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA104716OtherLABOR & INDUSTRIES
WA8931440OtherCRIME VICTIMS COMP
5899059OtherAETNA
FR9546OtherREGENCE BLUESHIELD
070008998OtherRAILROAD MEDICARE
WA8186256Medicaid
BF4722903OtherDEA
BF4722903OtherDEA
WAG000250713Medicare PIN
G8878114Medicare PIN
WAG000250458Medicare PIN
WAG000250514Medicare PIN
WA8931440OtherCRIME VICTIMS COMP
G21742Medicare UPIN
070008998OtherRAILROAD MEDICARE
WAG115136447Medicare PIN