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NPI Code Detail

MEDICARE: PETER KIM M.D.

MEDICARE: PETER KIM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician01050900AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760471593
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER KIM M.D.
Provider Business Mailing Address
First Line : 3401 E RAYMOND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-4744
Country : US
Telephone Number : 317-788-9769
Fax Number : 317-781-4868
Provider Business Practice Location Address
First Line : 901 SHELBY ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-1151
Country : US
Telephone Number : 317-488-2040
Fax Number : 317-488-2051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 09/08/2011

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