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General NPI Number Information
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NPI Number | 1972919116
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Entity Type | Organization
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Legal Business Name | KINGS MEDICAL GROUP PC
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 808 VAUGHN ST
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City | HANFORD
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State | CA
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Zip | 93230
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Country | US
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Telephone | 559-410-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 240 N 12TH AVE SUITE 109 #303
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City | HANFORD
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State | CA
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Zip | 93230-5995
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Country | US
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Telephone | 559-410-8404
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN R GAVINI
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Credential | M.D.
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Telephone | 559-410-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A77882
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License Number State | CA
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