Healthcare Provider Details

I. General information

NPI: 1356284871
Provider Name (Legal Business Name): DANIEL KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 RIDGEWAY LOOP RD STE 108
MEMPHIS TN
38120-4026
US

IV. Provider business mailing address

871 RIDGEWAY LOOP RD STE 108
MEMPHIS TN
38120-4026
US

V. Phone/Fax

Practice location:
  • Phone: 901-295-0199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42634
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: