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Organization
SOUTH DRIVE MEDICAL CLINIC
Active
Organization
SOUTH DRIVE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH S PETERS MD (PRESIDENT)
(650) 961-9430
Entity
Organization
Contact information
Practice address
515 S DRIVE, #15, MOUNTAIN VIEW, CA 94040-4209
(650) 961-9430
Mailing address
515 S DRIVE, #15, MOUNTAIN VIEW, CA 94040-4209
(650) 961-9430
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY4724
CA
207R00000X
Internal Medicine Physician
G33788
CA
Other
Enumeration date
06/30/2006
Last updated
09/11/2025
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