Provider Demographics
NPI:1982013595
Name:KIM, RICHARD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 HARDING AVE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3735
Mailing Address - Country:US
Mailing Address - Phone:808-739-1992
Mailing Address - Fax:808-739-1995
Practice Address - Street 1:3615 HARDING AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3735
Practice Address - Country:US
Practice Address - Phone:808-739-1992
Practice Address - Fax:808-739-1995
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical