MEDICARE: KINGS WELLNESS INC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1164376521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS WELLNESS INC

Provider Business Mailing Address
First Line	:	7043 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9132
Country	:	US
Telephone Number	:	513-804-3266
Fax Number	:	800-565-3179

Provider Business Practice Location Address
First Line	:	7043 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9132
Country	:	US
Telephone Number	:	513-804-3266
Fax Number	:	800-565-3179

Authorized Official
Title or Position	:	OWNER
Name	:	TATUM KING
Credential	:	PHARMD
Telephone Number	:	440-567-0414

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	03/05/2026

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