Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | D00065837 | MD |
N | 207VG0400X | Gynecologist | 223931 | NY |
NPI | 1114986817 |
---|---|
Provider Name | Daniel Kim |
First Address | Baltimore, MD 21215-5229 |
Second Address | Baltimore, MD 21215-5229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 27/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02248355 | (05) | NY |
H05821 | (02) |