Provider Demographics
NPI:1609810779
Name:KIM, RICHARD D (M D)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:KIM
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26945 AMHEARST CIR APT 211
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7568
Mailing Address - Country:US
Mailing Address - Phone:216-765-0532
Mailing Address - Fax:216-444-9464
Practice Address - Street 1:9500 EUCLID AVE # R35
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-0293
Practice Address - Fax:216-444-9464
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041492207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT034257OtherCONTROLLED SUBSTANCE REG.