Peter Euidon Kim, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE60468228 Issued in WA

Practice address

2100 E Section St Ste 103
Mount Vernon, WA 98274-9132

Phone

(360) 424-7057

Fax

(360) 424-7058

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peter E. Kim, DDS, PS

  • Oral and Maxillofacial Surgery Clinic/Center
  • Mount Vernon, WA
  • NPI 1457751273
  NPD (past) Authorized official

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1184717654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E SECTION ST STE 103",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982749132",
            "telephone_number": "360-424-7057",
            "fax_number": "360-424-7058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 E SECTION ST STE 103",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982749132",
            "telephone_number": "360-424-7057",
            "fax_number": "360-424-7058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PETER",
        "middle_name": "EUIDON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE60468228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila M Kenning, ARNP
• Kristi J Kersten-Tenborg
• Mathangi Suresh Keshavan, DO
• Kathleen Sharon Ketcham, M.A.,LMFT
• Kidney & Hypertension Clinic PLLC
• Yujin Kim, DO
• Anne P Kinney
• Shaun Evan Kisser, D.P.T.
• Alin Ray Kitchens Jr., LMP
• KLDW Enterprises LLC

• Oral and Maxillofacial Surgery (Dentist) in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.