Provider Demographics
NPI:1174866107
Name:KEYME, RICHARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:KEYME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WOO
Other - Middle Name:J
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1604 BLOSSOM HILL RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6350
Mailing Address - Country:US
Mailing Address - Phone:408-528-8833
Mailing Address - Fax:408-827-4171
Practice Address - Street 1:1604 BLOSSOM HILL RD STE 10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-6350
Practice Address - Country:US
Practice Address - Phone:408-528-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19411208100000X
CAA1334222081P0301X, 2081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA133422OtherCALIFORNIA MEDICAL LICENSE
FK5793218OtherDEA NUMBER