Provider Demographics
NPI:1265801476
Name:RICHARD B KIM MD MS INC.
Entity type:Organization
Organization Name:RICHARD B KIM MD MS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:949-988-7855
Mailing Address - Street 1:3501 JAMBOREE RD
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2939
Mailing Address - Country:US
Mailing Address - Phone:949-988-7855
Mailing Address - Fax:
Practice Address - Street 1:3501 JAMBOREE RD
Practice Address - Street 2:SUITE 1250
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2939
Practice Address - Country:US
Practice Address - Phone:949-988-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84650207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty