Provider Demographics
NPI:1992742910
Name:KIM, DANIEL S (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5500 KNOLL NORTH DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2370
Mailing Address - Country:US
Mailing Address - Phone:443-632-7017
Mailing Address - Fax:
Practice Address - Street 1:5500 KNOLL NORTH DR
Practice Address - Street 2:SUITE 290
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2370
Practice Address - Country:US
Practice Address - Phone:443-632-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2399042084P0800X
MDD00682202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI52908Medicare UPIN
NY611BH1Medicare PIN