Provider Demographics
NPI:1902331028
Name:DIN, PETER JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:DIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 FREEPORT BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2015
Mailing Address - Country:US
Mailing Address - Phone:916-431-7384
Mailing Address - Fax:916-244-9653
Practice Address - Street 1:4617 FREEPORT BLVD STE F
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2015
Practice Address - Country:US
Practice Address - Phone:916-431-7384
Practice Address - Fax:916-244-9653
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020680207Q00000X
CA20A19428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine