Healthcare Provider Details

I. General information

NPI: 1851447650
Provider Name (Legal Business Name): DANIEL D KIM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 S HARBOR BLVD STE 5
LA HABRA CA
90631
US

IV. Provider business mailing address

1480 S HARBOR BLVD STE 5
LA HABRA CA
90631-7564
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-5200
  • Fax:
Mailing address:
  • Phone: 714-870-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: