Provider Demographics
NPI:1790927580
Name:KIM, RICHARD KYUNGHO (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KYUNGHO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:499 E HAMPDEN AVE #220
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2792
Mailing Address - Country:US
Mailing Address - Phone:303-783-8844
Mailing Address - Fax:303-783-2002
Practice Address - Street 1:1210 MEDICAL ARTS BLVD STE 217B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3461
Practice Address - Country:US
Practice Address - Phone:765-298-4470
Practice Address - Fax:765-298-4975
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT190323207T00000X
CO55280207T00000X
IN01074190A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300054280Medicaid
PAMT190323OtherSTATE OF PA