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1497041438 NPI number — PETER P KIM

NPI Number: 1497041438
Health Care Provider/Practitioner: PETER P KIM

Information about “1497041438” NPI (PETER P KIM) exists in 1497041438 in HTML format HTML  |  1497041438 in plain Text format TXT  |  1497041438 in PDF (Portable Document Format) PDF  |  1497041438 in an XML format XML  formats.

NPI Number : 1497041438 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497041438",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIM",
    "FirstName": "PETER",
    "MiddleName": "P",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10280 INDIANA AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIVERSIDE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92503-5357",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-343-0428",
    "MailingAddressFaxNumber": "951-343-0438",
    "FirstLinePracticeLocationAddress": "720 S. RAMONA AVE.",
    "SecondLinePracticeLocationAddress": "SUITE 103",
    "PracticeLocationAddressCityName": "CORONA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92879-2147",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-735-1677",
    "PracticeLocationAddressFaxNumber": "951-735-7611",
    "EnumerationDate": "06/28/2011",
    "LastUpdateDate": "01/05/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225000000X",
          "TaxonomyName": "Orthotic Fitter",
          "LicenseNumber": "53282",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": "53282",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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