Provider Demographics
NPI:1922022458
Name:KIM, PETER UNG KWON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:UNG KWON
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 E LAMBERT RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-8001
Mailing Address - Country:US
Mailing Address - Phone:714-529-0100
Mailing Address - Fax:714-599-9898
Practice Address - Street 1:1770 E LAMBERT RD STE 110
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-8001
Practice Address - Country:US
Practice Address - Phone:714-529-0100
Practice Address - Fax:714-599-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD49769-01OtherDENTI-CAL