Kirk J Petersen DMD Professional Corp.

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

35534 Issued in CA

Legal business name

KIRK J PETERSEN DMD PROFESSIONAL CORP.

Doing business as

Hemet West Dental Office

Practice address

3232 W Florida Ave
Hemet, CA 92545-3622

Phone

(951) 652-4464

Fax

(951) 929-7090

NPI assigned

Jul 16, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Kirk J Petersen, DMDNPI 1285638106

Title

President

Phone

(951) 652-4464

Specialties & licenses 1

Addresses

Other names 1

• Hemet West Dental Office 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.

• Kirk John Petersen, D.M.D.

  • Dentist
  • Smith River, CA
  • NPI 1285638106
  NPD (past) Authorized official

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1750722930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 W FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925453622",
            "telephone_number": "951-652-4464",
            "fax_number": "951-929-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 W FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925453622",
            "telephone_number": "951-652-4464",
            "fax_number": "951-929-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRK J PETERSEN DMD PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-652-4464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "CA",
            "license": "35534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hemet West Dental Office",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Wonjun Kim
• Samuel Kim, PHARMD
• Jacqueline Olvera Kincaid
• Dean E King, O.D.
• Siera King
• Avegil Portia Solomon Klebel
• KMB Investments Inc (The Corner Drug Store)
• Sharon Kay Knepfler, M.D.
• Anna Knight, FNP
• Rimel Knox

• Customized Equipment (DME) in Hemet, CA
• Providers in Hemet, CA by specialty
• Customized Equipment (DME) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.