Basic Information
| Provider Information | |||||||||
| NPI: | 1871028894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIEVES-KIM | ||||||||
| FirstName: | DANNY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 6TH AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112174898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474142749 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1403 LOMITA BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907102076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105347600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207QA0401X | A157693 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.