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General NPI Number Information
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NPI Number | 1225413149
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Entity Type | Individual
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Provider Name | DANIEL KIM
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Gender | Male
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 6122 W LAKE MEAD BLVD STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89108-2659
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Country | US
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Telephone | 412-951-2799
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Fax |
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Provider Business Mailing Address
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Address Line | 5994 DAY RIDER AVE
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City | LAS VEGAS
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State | NV
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Zip | 89139-6314
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Country | US
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Telephone | 412-951-2799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31228
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-184C
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License Number State | NV
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