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NPI Code Detail

MEDICARE: DR. PETER HYUN-SOO KIM D.O.

MEDICARE: DR. PETER HYUN-SOO KIM D.O.
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
1208000000XPediatrics Physician20A7153CA

General Provider Information

NPI Number : 1003873761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER HYUN-SOO KIM D.O.
Provider Business Mailing Address
First Line : 8695 SPECTRUM CENTER BLVD # 4004
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1489
Country : US
Telephone Number : 858-499-4416
Fax Number :
Provider Business Practice Location Address
First Line : 8695 SPECTRUM CENTER BLVD # 4004
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1489
Country : US
Telephone Number : 858-499-4416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 11/28/2022

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