Active NPI
Peter J Kim, DDS
- General Practice Dentistry
- Sacramento, CA
National Provider Identifier
1326224650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 56568
- Practice address
- 3406 American River Dr
Sacramento, CA 95864-5746 - Phone
- (916) 481-2000
- NPI assigned
- Jan 16, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 56568 | CA | Primary |
Addresses
Primary practice location
3406 American River Dr
Sacramento, CA 95864-5746
Mailing address
6436 Mauana Way
Citrus Heights, CA 95610-5009
Phone (415) 730-6494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160420001945 | CA | Order and Referring Only - Dentist | 7517265721 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252540800000",
"number": "1326224650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6436 MAUANA WAY",
"city": "CITRUS HEIGHTS",
"state": "CA",
"postal_code": "956105009",
"telephone_number": "415-730-6494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3406 AMERICAN RIVER DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958645746",
"telephone_number": "916-481-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "PETER",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-16",
"last_updated": "2009-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "56568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; 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.