Provider Demographics
NPI:1932128071
Name:KIM, PETER D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAE
Other - Middle Name:H
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11304 ROTHERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9487
Mailing Address - Country:US
Mailing Address - Phone:213-500-5253
Mailing Address - Fax:
Practice Address - Street 1:5120 STOCKDALE HWY STE D
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2673
Practice Address - Country:US
Practice Address - Phone:661-324-5442
Practice Address - Fax:661-324-5445
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist