Provider Demographics
NPI:1437237005
Name:KIM, RAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAN
Middle Name:S
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 1:365 LENNON LN
Mailing Address - Street 2:STE. 290
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5910
Mailing Address - Country:US
Mailing Address - Phone:925-274-9000
Mailing Address - Fax:925-274-9004
Practice Address - Street 1:365 LENNON LN
Practice Address - Street 2:SUITE 290
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5910
Practice Address - Country:US
Practice Address - Phone:925-274-9000
Practice Address - Fax:925-274-9004
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75587208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G755870Medicare ID - Type Unspecified
CAF83274Medicare UPIN