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General NPI Number Information
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NPI Number | 1689873671
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Entity Type | Individual
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Provider Name | KAHINA ETOSSI KING DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 1015 DONALD LEE HOLLOWELL PKWY NW
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City | ATLANTA
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State | GA
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Zip | 30318-6653
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Country | US
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Telephone | 678-553-4924
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 438394
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City | CHICAGO
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State | IL
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Zip | 60643-8394
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Country | US
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Telephone | 773-609-2545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122505
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN122505
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DN122505
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License Number State | GA
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