Provider Demographics
NPI:1487026381
Name:KIM, ROY (RD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W RAMONA RD
Mailing Address - Street 2:APT 8
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-4144
Mailing Address - Country:US
Mailing Address - Phone:323-275-7925
Mailing Address - Fax:
Practice Address - Street 1:2900 W RAMONA RD
Practice Address - Street 2:APT 8
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-4144
Practice Address - Country:US
Practice Address - Phone:323-275-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1106104133N00000X, 133NN1002X, 133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered