Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 53282 | CA |
NPI | 1497041438 |
---|---|
Provider Name | Peter P Kim |
First Address | Riverside, CA 92503-5357 |
Second Address | Corona, CA 92879-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 05/01/2012 |