Healthcare Provider Details

I. General information

NPI: 1407833932
Provider Name (Legal Business Name): RICHARD KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W ESSEX ST STE 203
MAYWOOD NJ
07607-1023
US

IV. Provider business mailing address

PO BOX 626
GREAT RIVER NY
11739-0626
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-7766
  • Fax: 201-880-7763
Mailing address:
  • Phone: 631-892-2745
  • Fax: 631-201-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number25MA08272800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MA08272800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: