Healthcare Provider Details

I. General information

NPI: 1083965321
Provider Name (Legal Business Name): KENNETH R KING MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 114TH AVE SE STE 210
BELLEVUE WA
98004-6956
US

IV. Provider business mailing address

1621 114TH AVE SE STE 210
BELLEVUE WA
98004-6956
US

V. Phone/Fax

Practice location:
  • Phone: 425-646-2960
  • Fax:
Mailing address:
  • Phone: 425-646-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMD00016091
License Number StateWA

VIII. Authorized Official

Name: DR. KENNETH R KING
Title or Position: PRESIDENT
Credential: MD
Phone: 425-646-2960