1629047329 NPI number — DANIEL KIM, M.D., TOTAL EYE CARE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629047329 NPI number — DANIEL KIM, M.D., TOTAL EYE CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL KIM, M.D., TOTAL EYE CARE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629047329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13633 37TH AVE STE 4C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11354-4562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-661-3800
Provider Business Mailing Address Fax Number:
718-661-3812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4161 KISSENA BLVD
Provider Second Line Business Practice Location Address:
C#24
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-661-3800
Provider Business Practice Location Address Fax Number:
718-661-3812
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RYU
Authorized Official First Name:
SUNG
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
718-661-3800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  194095 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113385110 . This is a "UNICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2033258 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01755297 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1309275 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6013281 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 67S631 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C7998 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P627446 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113385110003 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5143562 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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