Healthcare Provider Details

I. General information

NPI: 1174866107
Provider Name (Legal Business Name): RICHARD W KEYME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WOO J KIM MD

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 07/21/2022
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

IV. Provider business mailing address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-8833
  • Fax:
Mailing address:
  • Phone: 408-528-8833
  • Fax: 408-827-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number19411
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA133422
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA133422
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA133422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: