MEDICARE: DANIEL YOUNG KIM DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	7328	OK

General Provider Information

NPI Number	:	1558990028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL YOUNG KIM DO

Provider Business Mailing Address
First Line	:	4502 E 41ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2536
Country	:	US
Telephone Number	:	918-619-4400
Fax Number	:	918-619-4334

Provider Business Practice Location Address
First Line	:	430 BRYAN DR
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-3467
Country	:	US
Telephone Number	:	580-920-1980
Fax Number	:	580-920-9937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	06/17/2024

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Directions to “ DANIEL YOUNG KIM DO” Practice Location

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