Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 20A7153 | CA |
NPI | 1003873761 |
---|---|
Provider Name | Dr. Peter Hyun-Soo Kim |
First Address | Apo, AE 09461-5115 |
Second Address | Apo, AE 09461-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 10/04/2018 |