MEDICARE: DR. BYRON KING MD, INC,

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	207XS0106X	Orthopaedic Hand Surgery Physician	G26948	CA

General Provider Information

NPI Number	:	1548371925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON KING MD, INC,

Provider Business Mailing Address
First Line	:	3939 RUFFIN RD STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1815
Country	:	US
Telephone Number	:	858-560-0422
Fax Number	:	858-633-0392

Provider Business Practice Location Address
First Line	:	3939 RUFFIN RD STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1815
Country	:	US
Telephone Number	:	858-560-0422
Fax Number	:	858-633-0392

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/19/2009

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