Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01063684A | IN |
N | 208600000X | Surgeon | 01063684A | IN |
Y | 208200000X | Surgeon | MD60650940 | WA |
Y | 208600000X | Surgeon | MD60650940 | WA |
N | 208200000X | Surgeon | P5094 | TX |
N | 208600000X | Surgeon | P5094 | TX |
NPI | 1013125046 |
---|---|
Provider Name | Dr. Danny Song Kim |
First Address | Tacoma, WA 98405-4234 |
Second Address | Auburn, WA 98001-4931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 30/11/2016 |