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General NPI Number Information
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NPI Number | 1982101044
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Entity Type | Organization
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Legal Business Name | DK MD, INC.
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 4302 HOLLYWOOD BLVD # 267
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6635
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Country | US
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Telephone | 786-774-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 4302 HOLLYWOOD BLVD # 267
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6635
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEREK KING
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Credential | MD
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Telephone | 786-774-2246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | ME135881
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License Number State | FL
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