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General NPI Number Information
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NPI Number | 1780983437
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Entity Type | Individual
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Provider Name | DOMINIC M KING D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7010 ENGLE RD
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City | CLEVELAND
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State | OH
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Zip | 44130-8401
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Country | US
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Telephone | 440-260-3731
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Fax | 440-239-0979
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE # DESKA4
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-8960
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Fax | 440-239-0979
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 58.004005
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 3401178
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 3401178
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License Number State | OH
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