Healthcare Provider Details

I. General information

NPI: 1598468134
Provider Name (Legal Business Name): DANIEL J KIM MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROADWAY ST # MC5334
REDWOOD CITY CA
94063-3132
US

IV. Provider business mailing address

450 BROADWAY ST # MC5334
REDWOOD CITY CA
94063-3132
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-7190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA199164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: