=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992641013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINGDRIVE LOGISTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2026
-----------------------------------------------------
Last Update Date | 04/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6443 STONEY VIEW LN UNIT 2
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93063-6420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-456-4378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6443 STONEY VIEW LN UNIT 2
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93063-6420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-456-4378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | MICHAEL COTTRELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-934-1132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------