Healthcare Provider Details

I. General information

NPI: 1245333533
Provider Name (Legal Business Name): JENNIFER KING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 CHAIN BRIDGES ROAD
FALLS CHURCH VA
22030
US

IV. Provider business mailing address

2411 DAKOTA LAKES DR
HERNDON VA
20171-2994
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-3111
  • Fax: 904-346-0113
Mailing address:
  • Phone: 703-810-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101052115
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: