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Peter Lee Kim

Family Medicine

Allopathic & Osteopathic Physicians

660 Baker St Ste A101, Costa Mesa, CA 92626-4407

PECOS Enrollment

This provider is enrolled in PECOS as PETER KIM.

Based on the most recent information from CMS, provider Peter Lee Kim is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1609815224
Provider Type
Individual
Full Name
Kim, Peter Lee
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
6/6/2006
Last Updated
3/28/2025

Contact Information

Practice Location

660 Baker St Ste A101, Costa Mesa, CA 92626-4407

(714) 668-2500

(714) 668-2515

Mailing Location

PO Box 2218, Suisun City, CA 94585-5218

(657) 241-3600

(657) 241-7708

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License G77031 California
Code 207QS0010X	Description Family Medicine Allopathic & Osteopathic Physicians	License G77031 California

Provider Identifiers

ID	Description	Issuer
ID 1609815224	Description Medicaid	Issuer Unlisted California
ID P00425054	Description Other	Issuer MEDICARE RAILROAD California

Peter Lee Kim

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Ahmed, Nazli

Eppele, Claudia

Shaw, Pravin

Doan, Loi

Acosta, Arturo

Wass, Adam M

Jeff P. Deleon, Do., Inc.

Horejsi, Joseph

Hoag Medical Group Inc.

Nguyen, Gina-Nga T