Basic Information
| Provider Information | |||||||||
| NPI: | 1699748459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2580 HAYMAKER RD | ||||||||
| Address2: | PO BOX 2 SUITE 302 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128569074 | ||||||||
| FaxNumber: | 4128565871 | ||||||||
| Practice Location | |||||||||
| Address1: | 2580 HAYMAKER RD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128569074 | ||||||||
| FaxNumber: | 4128565871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 04/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 05012300 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1746700 | 01 | PA | HIGHMARK | OTHER | 1013441990001 | 05 | PA | MEDICAID |