MEDICARE: MR. ROY DEAN KING LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS19976	CA

General Provider Information

NPI Number	:	1003900093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROY DEAN KING LCSW

Provider Business Mailing Address
First Line	:	921 E COMPTON BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3303
Country	:	US
Telephone Number	:	310-668-6993
Fax Number	:	310-223-0694

Provider Business Practice Location Address
First Line	:	1720 E 120TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3052
Country	:	US
Telephone Number	:	310-668-4371
Fax Number	:	310-898-3485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/13/2013

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