Provider Demographics
NPI:1821257528
Name:KIM, PETER SIMON (DPM, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SIMON
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM, MS
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3156
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3156
Mailing Address - Country:US
Mailing Address - Phone:310-228-0396
Mailing Address - Fax:310-530-1595
Practice Address - Street 1:5220 PACIFIC CONCOURSE DR
Practice Address - Street 2:STE 120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6244
Practice Address - Country:US
Practice Address - Phone:310-228-0396
Practice Address - Fax:888-492-2900
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4672213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4672OtherSTATE LICENSE
BK9847320OtherDEA