Healthcare Provider Details

I. General information

NPI: 1770858573
Provider Name (Legal Business Name): JUSTIN B KING MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2309
SAN DIEGO CA
92120-5241
US

IV. Provider business mailing address

PO BOX 880768
SAN DIEGO CA
92168-0768
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-8803
  • Fax: 619-286-2344
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA89447
License Number StateCA

VIII. Authorized Official

Name: DR. JUSTIN BENARD KING
Title or Position: PRESIDENT
Credential: MD
Phone: 310-462-8668