Provider Demographics
NPI:1215279922
Name:KIM, DANIEL S (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4311 CARSWELL AVE
Mailing Address - Street 2:BLDG 340
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-7069
Mailing Address - Country:US
Mailing Address - Phone:702-653-2766
Mailing Address - Fax:702-653-2766
Practice Address - Street 1:4311 CARSWELL AVE
Practice Address - Street 2:BLDG 340
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-7069
Practice Address - Country:US
Practice Address - Phone:702-653-2766
Practice Address - Fax:702-653-2766
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02004322A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice