Organization
PETER P. KIM
Active
Other names
Riverside Medical Supply, Co.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER P KIM RN (OWNER)
(951) 343-0428
Entity
Organization
Contact information
Practice address
10280 INDIANA AVE, RIVERSIDE, CA 92503-5357
(951) 343-0428
(951) 343-0438
Mailing address
10280 INDIANA AVE, RIVERSIDE, CA 92503-5357
(951) 343-0428
(951) 343-0438
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
44384
CA
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17867
HMDR EXEMPTEE LICENSE
CA
01
—
44384
HOME MED DEVICE RETAIL
CA
05
—
9424937
—
CA
Enumeration date
08/21/2006
Last updated
01/26/2011
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