Provider Demographics
NPI:1619117280
Name:KIM, DANIEL Y (LAC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2677
Mailing Address - Country:US
Mailing Address - Phone:718-463-2700
Mailing Address - Fax:718-463-6174
Practice Address - Street 1:16410 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2677
Practice Address - Country:US
Practice Address - Phone:718-463-2700
Practice Address - Fax:718-463-6174
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002758-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist