=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760730238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. CHELSEA JEAN KING
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2012
-----------------------------------------------------
Last Update Date | 08/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 HUDSON ST
-----------------------------------------------------
City | HAMPTON BAYS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11946-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-594-1273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 HUDSON ST
-----------------------------------------------------
City | HAMPTON BAYS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11946-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-594-1273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 841220
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------