Healthcare Provider Details

I. General information

NPI: 1194875765
Provider Name (Legal Business Name): KINGS CLINIC AND URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W. KING STREET SUITE 20
KINGS MOUNTAIN NC
28086-3345
US

IV. Provider business mailing address

407 W. KING STREET SUITE 20
KINGS MOUNTAIN NC
28086-3345
US

V. Phone/Fax

Practice location:
  • Phone: 704-730-8461
  • Fax:
Mailing address:
  • Phone: 704-730-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200001048
License Number StateNC

VIII. Authorized Official

Name: DR. TEMIDAYO ADESOJI ADELEKUN
Title or Position: MEMBER
Credential: MD
Phone: 704-730-8461