Healthcare Provider Details

I. General information

NPI: 1982516530
Provider Name (Legal Business Name): RAN S. KIM, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 YGNACIO VALLEY RD STE 11D
WALNUT CREEK CA
94598-2874
US

IV. Provider business mailing address

1399 YGNACIO VALLEY RD STE 11D
WALNUT CREEK CA
94598-2874
US

V. Phone/Fax

Practice location:
  • Phone: 925-430-5613
  • Fax: 510-340-5420
Mailing address:
  • Phone: 925-430-5613
  • Fax: 510-340-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAN KIM
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 925-787-2914