Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 01071893A | IN |
NPI | 1023276029 |
---|---|
Provider Name | Daniel L Kim |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46256-1738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201163920 | (05) | IN |
P01214126 | RR MEDICARE PTAN (01) | IN |