Individual
PETER P KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
720 S. RAMONA AVE., SUITE 103, CORONA, CA 92879-2147
(951) 735-1677
(951) 735-7611
Mailing address
10280 INDIANA AVE, RIVERSIDE, CA 92503-5357
(951) 343-0428
(951) 343-0438
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
53282
CA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
53282
CA
Other
Enumeration date
06/28/2011
Last updated
01/05/2012
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