=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629047329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL KIM, M.D., TOTAL EYE CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2006
-----------------------------------------------------
Last Update Date | 04/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4161 KISSENA BLVD C#24
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-3105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-661-3800
-----------------------------------------------------
Fax | 718-661-3812
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13633 37TH AVE STE 4C
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354-4562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-661-3800
-----------------------------------------------------
Fax | 718-661-3812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SUNG RYU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-661-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 194095
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------