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General NPI Number Information
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NPI Number | 1346210754
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Entity Type | Individual
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Provider Name | DANIEL S MCKIM P.A.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1700 N CHRISMAN RD
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City | TRACY
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State | CA
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Zip | 95304-9314
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Country | US
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Telephone | 925-759-4987
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 CHAMBERS CIR
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City | BRENTWOOD
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State | CA
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Zip | 94513-5922
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Country | US
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Telephone | 925-759-4987
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1045485
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License Number State |
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