Healthcare Provider Details

I. General information

NPI: 1528344751
Provider Name (Legal Business Name): DANIEL JOHN KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 STRAWBERRY TER
DAVIS CA
95616-1377
US

IV. Provider business mailing address

1056 STRAWBERRY TER
DAVIS CA
95616-1377
US

V. Phone/Fax

Practice location:
  • Phone: 415-265-3440
  • Fax:
Mailing address:
  • Phone: 415-265-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberGFE46545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: