Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | G64504 | CA |
NPI | 1124107818 |
---|---|
Provider Name | Peter Kim |
First Address | Oakland, CA 94612-3429 |
Second Address | Hayward, CA 94545-4235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G645040 | (05) | CA |
F72210 | (02) |