NPIMap

Organization Active NPI

Peter Kim, D.D.S., Professional Corp.

  • Preferred Provider Organization
  • Cerritos, CA
National Provider Identifier
1376964064
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
49769 Issued in CA
Legal business name
PETER KIM, D.D.S., PROFESSIONAL CORP.
Practice address
11899 Del Amo Blvd
Cerritos, CA 90703-7605
Phone
(562) 402-4411
Fax
(562) 402-5052
NPI assigned
Dec 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

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
Preferred Provider Organization 305R00000X 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

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.

Locations

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

NPI Registry JSON

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

{
    "created_epoch": "1387756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387756800000",
    "number": "1376964064",
    "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., PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-23",
        "last_updated": "2013-12-23",
        "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": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "49769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 23, 2013; 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.