Healthcare Provider Details

I. General information

NPI: 1043905771
Provider Name (Legal Business Name): DANIEL KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

448 OPAL CT
ALTAMONTE SPRINGS FL
32714-5403
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-4000
  • Fax:
Mailing address:
  • Phone: 407-756-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS23161
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number114466
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number02009285A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: