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General NPI Number Information
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NPI Number | 1558387290
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Entity Type | Organization
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Legal Business Name | KING MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 4910 VAN NUYS BLVD SUITE 209
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1715
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Country | US
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Telephone | 818-728-4864
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Fax | 818-728-4848
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Provider Business Mailing Address
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Address Line | 4910 VAN NUYS BLVD SUITE 209
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1715
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Country | US
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Telephone | 818-728-4864
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Fax |
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Authorized Official
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Title or Position | CORPORATION SECRETARY
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Name | DR. CHARLES GERALD WILLSON KING
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Credential | M.D.
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Telephone | 818-728-4864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | G9781
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License Number State | CA
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