Peter Kim MD Inc

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

A67819 Issued in CA

Legal business name

PETER KIM MD INC

Practice address

1195 Roadrunner Way
Simi Valley, CA 93065-1210

Phone

(805) 579-8892

Fax

(805) 579-8951

NPI assigned

Jul 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Peter K Kim, M.D.NPI 1053534610

Title

President

Phone

(805) 579-8892

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

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

• Peter K. Kim, M.D.

  • Neurology Physician
  • Simi Valley, CA
  • NPI 1053534610

  Neuromuscular Medicine

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360627200000",
    "number": "1760411946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1195 ROADRUNNER WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930650000",
            "telephone_number": "805-579-8892",
            "fax_number": "805-579-8951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 ROADRUNNER WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651210",
            "telephone_number": "805-579-8892",
            "fax_number": "805-579-8951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER KIM MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2013-02-12",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-579-8892",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "CA",
            "license": "A67819",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A67819",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "CA",
            "license": "A67819",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A678190",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZ50179Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS FECA ID",
            "identifier": "609916600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emelia Perez, M.D.
• Maria Angeles Perez
• Katelynn Perlstein
• Perpetual Care Hospice, Inc.
• Keith Asukai Persico
• Petrosyan Enterprises, Inc.
• Anthony Thong Phan, M.D.
• Pharmtox
• Phillip Lavine Chiropractic Inc.
• Catherine McClain Phillips, PA C

• Neurology Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.