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NPI Code Detail

MEDICARE: DR. PETER KIM DDS

MEDICARE:  DR. PETER  KIM  DDS
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
1122300000XDentist108525CA

General Provider Information

NPI Number : 1467168153
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER KIM DDS
Provider Business Mailing Address
First Line : 325 N LARCHMONT BLVD UNIT 153
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3011
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 325 N LARCHMONT BLVD UNIT 153
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3011
Country : US
Telephone Number : 213-632-9631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2023
Last Update Date : 01/25/2023

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Directions to “ DR. PETER KIM DDS” Practice Location

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