Healthcare Provider Details

I. General information

NPI: 1316856156
Provider Name (Legal Business Name): RICHARD KIM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27921 GREENLAWN CIR
LAGUNA NIGUEL CA
92677-3754
US

IV. Provider business mailing address

27921 GREENLAWN CIR
LAGUNA NIGUEL CA
92677-3754
US

V. Phone/Fax

Practice location:
  • Phone: 917-687-6528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041303597
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: