MEDICARE: JORDAN KING

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	106S00000X	Behavior Technician		HI

General Provider Information

NPI Number	:	1295692309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN KING

Provider Business Mailing Address
First Line	:	73 PUUHONU PL STE 100
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-987-9321
Fax Number	:

Provider Business Practice Location Address
First Line	:	73 PUUHONU PL STE 100
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-987-9321
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ JORDAN KING ” Practice Location

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