Provider Demographics
NPI:1750701983
Name:PETER M. KAM, DDS, INC
Entity type:Organization
Organization Name:PETER M. KAM, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-571-0283
Mailing Address - Street 1:230 S GARFIELD AVE
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty