Provider Demographics
NPI:1003915661
Name:KIM, RONALD C (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 EAST SEVENTH STREET
Mailing Address - Street 2:DVAMC (05/113NP)
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822
Mailing Address - Country:US
Mailing Address - Phone:562-826-5513
Mailing Address - Fax:562-826-5623
Practice Address - Street 1:5901 EAST SEVENTH STREET
Practice Address - Street 2:DVAMC (05/113NP)
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822
Practice Address - Country:US
Practice Address - Phone:562-826-5513
Practice Address - Fax:562-826-5623
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13550207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG13550AOtherMEDICARE PTAN
CA00G135500OtherBLUE SHIELD
CA00G135500Medicaid
CA220027744OtherRAILROAD MEDICARE
CA220027744OtherRAILROAD MEDICARE
CAWG13550AOtherMEDICARE PTAN