Provider Demographics
NPI:1922024165
Name:RHIM-KIM, HAE RAN (MD)
Entity Type:Individual
Prefix:
First Name:HAE RAN
Middle Name:
Last Name:RHIM-KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAE RAN
Other - Middle Name:
Other - Last Name:RHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-877-5199
Mailing Address - Fax:
Practice Address - Street 1:4750 W OAKEY BLVD STE 3A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-877-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076328A207RR0500X, 207R00000X
NV18373207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK1907OtherPHYSICIAN PERMIT
TX752938004OtherTAX ID NUMBER
TX096644201Medicaid
TX0060DHOtherBCBS OF TEXAS
TX752938004OtherEIN
TXF67582Medicare UPIN
TX00461JMedicare PIN
$$$$$$$$$OtherSOCIAL SECURITY NUMBER