Healthcare Provider Details

I. General information

NPI: 1073582805
Provider Name (Legal Business Name): DANIEL Y. KIM, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BERGEN BLVD
PALISADES PARK NJ
07650-2322
US

IV. Provider business mailing address

540 BERGEN BLVD
PALISADES PARK NJ
07650-2322
US

V. Phone/Fax

Practice location:
  • Phone: 201-461-3970
  • Fax: 201-242-9061
Mailing address:
  • Phone: 201-461-3970
  • Fax: 201-242-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA65006
License Number StateNJ

VIII. Authorized Official

Name: LENA KIM
Title or Position: BILLING
Credential:
Phone: 201-461-3970