Healthcare Provider Details

I. General information

NPI: 1477902419
Provider Name (Legal Business Name): DANIEL KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD STE SB290
W HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

1775 STATE HIGHWAY 26 APT 2147
GRAPEVINE TX
76051-2099
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5841
  • Fax:
Mailing address:
  • Phone: 310-750-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA152545
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberT0260
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: