Provider Demographics
NPI:1699748459
Name:KIM, RICHARD H (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAINT FRANCIS DR STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3973
Mailing Address - Country:US
Mailing Address - Phone:864-235-8396
Mailing Address - Fax:864-271-4092
Practice Address - Street 1:3 SAINT FRANCIS DR STE 400
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3973
Practice Address - Country:US
Practice Address - Phone:864-235-8396
Practice Address - Fax:864-271-4092
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05012300207RR0500X
SC82982207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013441990001Medicaid
PA1746700OtherHIGHMARK
PA1746700OtherHIGHMARK
PA093318Medicare PIN