Healthcare Provider Details

I. General information

NPI: 1922332410
Provider Name (Legal Business Name): KATHERINE KING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY STE 210
ALISO VIEJO CA
92656-5332
US

IV. Provider business mailing address

5 JOURNEY STE 210
ALISO VIEJO CA
92656-5332
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-7122
  • Fax: 949-305-7160
Mailing address:
  • Phone: 949-305-7122
  • Fax: 949-305-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: