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General NPI Number Information
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NPI Number | 1346993078
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Entity Type | Organization
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Legal Business Name | ELAINE Y. KING M.D.,INC.
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 4425 JAMBOREE RD STE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3044
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Country | US
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Telephone | 949-873-0399
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Fax | 949-539-9166
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Provider Business Mailing Address
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Address Line | 4425 JAMBOREE RD STE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3044
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Country | US
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Telephone | 949-873-0399
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Fax | 949-539-8166
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Authorized Official
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Title or Position | CEO
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Name | ELAINE KING
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Credential | MD
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Telephone | 949-873-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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