Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY19028 | CA |
Y | 103T00000X | Psychologist | PSY19028 | CA |
NPI | 1013096551 |
---|---|
Provider Name | Dr. Daneil Imkyu Kim |
First Address | Northridge, CA 91326-3826 |
Second Address | Los Angeles, CA 90020-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 17/10/2011 |