Healthcare Provider Details

I. General information

NPI: 1619354321
Provider Name (Legal Business Name): TERRI NICOLE KING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 64TH ST STE 150
EMERYVILLE CA
94608-2267
US

IV. Provider business mailing address

1480 64TH ST STE 150
EMERYVILLE CA
94608-2267
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA169885
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA169886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: