Peter P. Kim

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

44384 Issued in CA

Legal business name

PETER P. KIM

Doing business as

Riverside Medical Supply, Co.

Practice address

10280 Indiana Ave
Riverside, CA 92503-5357

Phone

(951) 343-0428

Fax

(951) 343-0438

NPI assigned

Aug 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Peter P Kim, RN

Title

Owner

Phone

(951) 343-0428

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Riverside Medical Supply, Co. Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296000000000",
    "number": "1164538369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10280 INDIANA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035357",
            "telephone_number": "951-343-0428",
            "fax_number": "951-343-0438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10280 INDIANA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035357",
            "telephone_number": "951-343-0428",
            "fax_number": "951-343-0438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER P. KIM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2011-01-26",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-343-0428",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "44384",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMDR EXEMPTEE LICENSE",
            "identifier": "17867",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME MED DEVICE RETAIL",
            "identifier": "44384",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9424937",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Medical Supply, Co.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Blake Perryman, DPT
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• Marlene Personett
• Pes-Ebs.Inc.
• Richard Dominic Pesavento, M.D.
• Peter Y. Chang, M.D., PH.D., Inc.
• Brooke Marie Peterman, BA
• Jason Howard Peterman, RN
• Peters & Peters DDS
• Peters Dental Corporation

• Durable Medical Equipment & Medical Supplies in Riverside, CA
• Providers in Riverside, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.