Peter Kim Md Inc | |
1195 Roadrunner Way Simi Valley CA 93065-1210 | |
(805) 579-8892 | |
(805) 579-8951 |
Full Name | Peter Kim Md Inc |
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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 |
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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 |
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Provider Enumeration Date | 07/01/2006 |
Last Update Date | 02/12/2013 |
Medicare PECOS PAC ID | 0840398913 |
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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 |
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Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1053534610 PECOS PAC ID: 2466348537 Enrollment ID: I20040225000674 |
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