Provider Demographics
NPI:1558004846
Name:KIM, DANIEL YOUNGJOO
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:YOUNGJOO
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 1:27800 MEDICAL CENTER RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6408
Mailing Address - Country:US
Mailing Address - Phone:949-545-6605
Mailing Address - Fax:949-326-7509
Practice Address - Street 1:27800 MEDICAL CENTER RD STE 220
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6408
Practice Address - Country:US
Practice Address - Phone:969-545-6605
Practice Address - Fax:949-326-7509
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6150213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty