| Peter Kim Md Inc | |
|
1195 Roadrunner Way Simi Valley CA 93065-1210 | |
| (805) 579-8892 | |
| (805) 579-8951 |
| Full Name | Peter Kim Md Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1195 Roadrunner Way, Simi Valley, California |
| Authorized Official Name and Position | Peter K Kim (PRESIDENT) |
| Authorized Official Contact | 8055798892 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter Kim Md Inc 1195 Roadrunner Way Simi Valley CA 93065-0000 Ph: (805) 579-8892 | Peter Kim Md Inc 1195 Roadrunner Way Simi Valley CA 93065-1210 Ph: (805) 579-8892 |
| NPI Number | 1760411946 |
|---|---|
| Provider Enumeration Date | 07/01/2006 |
| Last Update Date | 02/12/2013 |
| Medicare PECOS PAC ID | 0840398913 |
|---|---|
| Medicare Enrollment ID | O20070613000494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760411946 | NPI | - | NPPES |
| 00A678190 | Medicaid | CA | |
| ZZZ50179Z | Other | CA | BLUE SHIELD OF CA |
| 609916600 | Other | CA | ACS FECA ID |
| Provider Name | Peter K Kim |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053534610 PECOS PAC ID: 2466348537 Enrollment ID: I20040225000674 |
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