MEDICARE: KORWIN KING D.D.S.

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	1223G0001X	General Practice Dentistry	DS 021893-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44296	OTHER	PA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1932191418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORWIN KING D.D.S.

Provider Business Mailing Address
First Line	:	116 E GRANDVIEW AVE
Second Line	:
City	:	ZELIENOPLE
State	:	PA
Zip	:	16063-1131
Country	:	US
Telephone Number	:	724-452-6020
Fax Number	:	724-452-8317

Provider Business Practice Location Address
First Line	:	116 E GRANDVIEW AVE
Second Line	:
City	:	ZELIENOPLE
State	:	PA
Zip	:	16063-1131
Country	:	US
Telephone Number	:	724-452-6020
Fax Number	:	724-452-8317

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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