Healthcare Provider Details

I. General information

NPI: 1205193414
Provider Name (Legal Business Name): EMILY CLARK KING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E FOOTHILL BLVD STE C
SAN DIMAS CA
91773-1255
US

IV. Provider business mailing address

615 E FOOTHILL BLVD STE C
SAN DIMAS CA
91773-1255
US

V. Phone/Fax

Practice location:
  • Phone: 909-243-1714
  • Fax:
Mailing address:
  • Phone: 909-243-1714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA130174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: