Individual
PETER CHANG KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4482 BARRANCA PKWY STE 228, IRVINE, CA 92604-1738
(949) 379-3080
(949) 379-3020
Mailing address
4482 BARRANCA PKWY, STE 228, IRVINE, CA 92604-1738
(949) 379-3080
(949) 379-3020
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
E4027
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000E40270
BLUE SHIELD
CA
05
—
000E40272
—
CA
01
—
1316930001
DNERC REG O
CA
Enumeration date
07/03/2006
Last updated
08/01/2022
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