Provider Demographics
NPI:1477598506
Name:KIM, ROBERT Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:Y
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 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA812112085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A8121111Medicare PIN
CA00A8121112Medicare PIN
CA00A8121117Medicare PIN
CA00A8121113Medicare PIN
CA00A8121114Medicare PIN
CA00A8121119Medicare PIN
CA00A812112Medicare PIN
CA00A812118Medicare PIN
CA00A8121120Medicare PIN
CA00A812116Medicare PIN
CA00A812117Medicare PIN
CA00A8121116Medicare PIN
CA00A812115Medicare PIN
CA00A8121118Medicare PIN
CA00A8121115Medicare PIN
CA00A812113Medicare PIN
CA00A812119Medicare PIN
CA00A812111Medicare PIN
CAI14527Medicare UPIN
CAP00220934Medicare PIN
CA00A8121121Medicare PIN
CA00A812114Medicare PIN
CA00A8121110Medicare PIN