Healthcare Provider Details

I. General information

NPI: 1174801344
Provider Name (Legal Business Name): DANIEL KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 CALLE LEE STE 117
LOS ALAMITOS CA
90720-6781
US

IV. Provider business mailing address

10541 CALLE LEE STE 117
LOS ALAMITOS CA
90720-6781
US

V. Phone/Fax

Practice location:
  • Phone: 714-794-2777
  • Fax: 714-276-2353
Mailing address:
  • Phone: 714-794-2777
  • Fax: 714-276-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA122585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: