MEDICARE: 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	G26948	CA

General Provider Information

NPI Number	:	1982743613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BYRON KING, MD, INC.

Provider Business Mailing Address
First Line	:	3939 RUFFIN RD
Second Line	:	SUITE 101
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
Second Line	:	SUITE 101
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	:	OWNER
Name	:	DR. BYRON F KING
Credential	:	M.D.
Telephone Number	:	858-560-0422

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	10/20/2009

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