Provider Demographics
NPI:1023436151
Name:KIM, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 N CENTRAL EXPY
Mailing Address - Street 2:STE 560
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4114
Mailing Address - Country:US
Mailing Address - Phone:310-749-0819
Mailing Address - Fax:
Practice Address - Street 1:8220 WALNUT HILL LN STE 408
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4417
Practice Address - Country:US
Practice Address - Phone:214-361-9777
Practice Address - Fax:214-891-0084
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7699207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS7699OtherMEDICAL LICENSE
TXS7699OtherMEDICAL LICENSE