Basic Information
| Provider Information | |||||||||
| NPI: | 1174801344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11691 ARGYLE DR | ||||||||
| Address2: | |||||||||
| City: | ROSSMOOR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907204035 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 W CARSON ST. | ||||||||
| Address2: | BOX 400 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102222401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2011 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A122585 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A122585 | 01 | CA | MEDICAL BOARD OF CALIFORNIA | OTHER |