NPIMap

Organization Active NPI

Peter Kim, D.D.S., P.C.

  • Dentist
  • Cerritos, CA
National Provider Identifier
1275753733
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
49769 Issued in CA
Legal business name
PETER KIM, D.D.S., P.C.
Practice address
11899 Del Amo Blvd
Cerritos, CA 90703-7605
Phone
(562) 402-4411
Fax
(562) 402-5052
NPI assigned
Apr 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Peter Ung Kwon Kim, D.D.S.
Title
President
Phone
(562) 402-4411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 49769 CA Primary

Addresses

Primary practice location

11899 Del Amo Blvd
Cerritos, CA 90703-7605

Mailing address

11899 Del Amo Blvd
Cerritos, CA 90703-7605
Phone (562) 402-4411

Other identifiers 1

IdentifierTypeStateIssuer
G92845-01OtherCADENTICAL

Other names 1

  • Del Amo Dental Office Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Del Amo Dental Office2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275753733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11899 DEL AMO BLVD",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907037605",
            "telephone_number": "562-402-4411",
            "fax_number": "562-402-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11899 DEL AMO BLVD",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907037605",
            "telephone_number": "562-402-4411",
            "fax_number": "562-402-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER KIM, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "UNG KWON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-402-4411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "49769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "G92845-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Del Amo Dental Office",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cerritos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.