Provider Demographics
NPI:1003168626
Name:PETER C KIM DPM INC
Entity Type:Organization
Organization Name:PETER C KIM DPM INC
Other - Org Name:IRVINE FOOT & ANKLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHANG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-379-3080
Mailing Address - Street 1:4482 BARRANCA PKWY STE 228
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1738
Mailing Address - Country:US
Mailing Address - Phone:949-379-3080
Mailing Address - Fax:
Practice Address - Street 1:4482 BARRANCA PKWY STE 228
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1738
Practice Address - Country:US
Practice Address - Phone:949-379-3080
Practice Address - Fax:949-379-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4027213ES0103X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40272Medicaid