MEDICARE: LARRY COOPER KING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	HA3557	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HA3557	OTHER	CA	LICENCE #

General Provider Information

NPI Number	:	1134261050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY COOPER KING

Provider Business Mailing Address
First Line	:	3520 OAKDALE RD STE. B
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95357
Country	:	US
Telephone Number	:	209-847-7775
Fax Number	:	209-847-7728

Provider Business Practice Location Address
First Line	:	3520 OAKDALE RD. STE. B
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95357-0714
Country	:	US
Telephone Number	:	209-847-7775
Fax Number	:	209-847-7728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/04/2011

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Directions to “ LARRY COOPER KING ” Practice Location

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