Daniel S Kim, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

02004322A Issued in IN

Practice address

4311 Carswell Ave
BLDG 340
Nellis Afb, NV 89191-7069

Phone

(702) 653-2766

Fax

(702) 653-2766

NPI assigned

Mar 20, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383696000000",
    "number": "1215279922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 CARSWELL AVE",
            "address_2": "BLDG 340",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891917069",
            "telephone_number": "702-653-2766",
            "fax_number": "702-653-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 CARSWELL AVE",
            "address_2": "BLDG 340",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891917069",
            "telephone_number": "702-653-2766",
            "fax_number": "702-653-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DANIEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-20",
        "last_updated": "2013-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02004322A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abby Kersey
• Vanessa Khalifa, PHARMD
• Samantha Kiernan, DO
• Mayson H Kile, IDMT
• Jaylynn Amber Rose Kilpatrick
• Grace Sun Kim, PA
• Haeseung Kim, DO
• Jenny H. Kim, O.D.
• Robin Jin Kim, PA
• Susun Theresa Kim, DMD

• General Practice Physician in Nellis Afb, NV
• Providers in Nellis Afb, NV by specialty
• General Practice Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.