Provider Demographics
NPI:1992764344
Name:KIM, RICHARD SEONGJUN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SEONGJUN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28647 S. WESTERN AVE.
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275
Mailing Address - Country:US
Mailing Address - Phone:310-882-0873
Mailing Address - Fax:310-881-1188
Practice Address - Street 1:28647 S. WESTERN AVE.
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275
Practice Address - Country:US
Practice Address - Phone:310-882-0873
Practice Address - Fax:310-881-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA69774OtherLICENSE
CAA69774OtherLICENSE
CAA69774OtherLICENSE
CABK6656776OtherDEA