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General NPI Number Information
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NPI Number | 1205117231
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Entity Type | Organization
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Legal Business Name | KING MEDICAL MANAGEMENT
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Dates
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Enumeration Date | 09/03/2011
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Last Update Date | 09/03/2011
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Provider Practice Location Address
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Address Line | 540 N GOLDEN CIRCLE DR SUITE 202
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City | SANTA ANA
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State | CA
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Zip | 92705-3914
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Country | US
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Telephone | 714-542-2153
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Fax | 714-464-4442
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Provider Business Mailing Address
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Address Line | PO BOX 6958
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-6958
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Country | US
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Telephone | 714-542-2153
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Fax | 714-464-4442
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Authorized Official
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Title or Position | OWNER
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Name | TANYA MORELAND
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Credential |
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Telephone | 714-542-2153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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