Healthcare Provider Details

I. General information

NPI: 1558895979
Provider Name (Legal Business Name): DANIEL S KIM DDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HIGHLANDS DR STE 106
LITITZ PA
17543-7507
US

IV. Provider business mailing address

104 MORNING DR
EPHRATA PA
17522-8452
US

V. Phone/Fax

Practice location:
  • Phone: 267-261-8796
  • Fax:
Mailing address:
  • Phone: 267-261-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD486291
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS044771
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: