MEDICARE: DR. DANIEL KIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036-108519	IL
2	2084P0805X	Geriatric Psychiatry Physician	036-108519	IL

General Provider Information

NPI Number	:	1295766483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL KIM MD

Provider Business Mailing Address
First Line	:	625 N MICHIGAN AVE
Second Line	:	SUITE 2550
City	:	CHICAGO
State	:	IL
Zip	:	60611-3110
Country	:	US
Telephone Number	:	312-640-7746
Fax Number	:	312-640-7736

Provider Business Practice Location Address
First Line	:	625 N MICHIGAN AVE
Second Line	:	SUITE 2500
City	:	CHICAGO
State	:	IL
Zip	:	60611-3110
Country	:	US
Telephone Number	:	312-640-7746
Fax Number	:	312-640-7736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/05/2016

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