Active NPI
Peter P Kim
- Durable Medical Equipment & Medical Supplies
- Corona, CA
National Provider Identifier
1497041438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 53282
- Practice address
- 720 S. Ramona Ave.
Suite 103
Corona, CA 92879-2147 - Phone
- (951) 735-1677
- Fax
- (951) 735-7611
- NPI assigned
- Jun 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | 53282 | CA | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 53282 | CA | Primary |
Addresses
Primary practice location
720 S. Ramona Ave.
Suite 103
Corona, CA 92879-2147
Mailing address
10280 Indiana Ave
Riverside, CA 92503-5357
Phone (951) 343-0428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325721600000",
"number": "1497041438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10280 INDIANA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925035357",
"telephone_number": "951-343-0428",
"fax_number": "951-343-0438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 S. RAMONA AVE.",
"address_2": "SUITE 103",
"city": "CORONA",
"state": "CA",
"postal_code": "928792147",
"telephone_number": "951-735-1677",
"fax_number": "951-735-7611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "PETER",
"middle_name": "P",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-28",
"last_updated": "2012-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "225000000X",
"taxonomy_group": "",
"desc": "Orthotic Fitter",
"state": "CA",
"license": "53282",
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CA",
"license": "53282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.