Provider Demographics
NPI:1184632135
Name:KAM, PETER MANLEUNG
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MANLEUNG
Last Name:KAM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:M
Other - Last Name:KAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:230 S GARFIELD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2900
Mailing Address - Country:US
Mailing Address - Phone:626-571-0283
Mailing Address - Fax:626-571-7825
Practice Address - Street 1:230 S GARFIELD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-2900
Practice Address - Country:US
Practice Address - Phone:626-571-0283
Practice Address - Fax:626-571-7825
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice