Peter E. Kim, DDS, PS

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

DE 60468228 Issued in WA

Legal business name

PETER E. KIM, DDS, PS

Doing business as

NORTH CASCADE IMPLANT AND ORAL SURGERY CENTER

Practice address

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

Phone

(360) 424-7057

Fax

(360) 424-7058

NPI assigned

Aug 28, 2014

Organization subpart

No

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

Authorized official

Name

Peter E Kim, DDSNPI 1184717654

Title

President

Phone

(513) 802-2799

Specialties & licenses 1

Addresses

Other names 1

• NORTH CASCADE IMPLANT AND ORAL SURGERY CENTER Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter Euidon Kim, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Mount Vernon, WA
  • NPI 1184717654
  NPD (past) Authorized official

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

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409184000000",
    "number": "1457751273",
    "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": {
        "organization_name": "PETER E. KIM, DDS, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-28",
        "last_updated": "2014-08-28",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-802-2799",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE 60468228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTH CASCADE IMPLANT AND ORAL SURGERY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Pereira, LICSW
• Performance Modalities Inc
• Blake J Perry, DDS
• Katherine Meg Perry, MS-CF-SLP
• Stacey Pestar, P.T.A.
• Amy Peterson, CP60614932
• Chelsea Mae Peterson, OTR/L
• Sherry Lee Peterson, ARNP
• Linda E Pettit, BA, CLN II
• Felicia M Petty, REGISTERED COUNSELOR

• Oral and Maxillofacial Surgery Clinic/Center in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; 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.