Provider Demographics
NPI:1609813476
Name:KIM, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2885 KAISER DR
Mailing Address - Street 2:BUILDING A
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-851-9200
Mailing Address - Fax:408-851-9201
Practice Address - Street 1:2885 KAISER DR
Practice Address - Street 2:BUILDING A
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051
Practice Address - Country:US
Practice Address - Phone:408-851-9200
Practice Address - Fax:408-851-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA223893208100000X
CAA96721208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation